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Maine rates for HCPCS Q4201

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$79.12 / $79.12 / $79.12
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$76.09 / $79.13 / $79.13
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$76.09 / $76.09 / $79.23
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$76.09 / $76.09 / $76.09
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$76.09 / $76.09 / $76.09
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$76.09 / $76.09 / $76.09
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$76.09 / $79.13 / $79.13
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$76.09 / $76.09 / $110.33