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Maine rates for HCPCS Q4196

PuraPly AM, per sq cm (add-on, list separately in addition to primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$101.03 / $105.07 / $108.34
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$89.86 / $112.32 / $320.16
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$101.03 / $101.03 / $101.03
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$101.03 / $101.03 / $101.03
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$101.03 / $101.03 / $101.03
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$101.03 / $101.03 / $101.03
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$101.03 / $105.07 / $108.34
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$101.03 / $101.03 / $146.49