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Maine rates for HCPCS Q4219

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

Facilitymedian $145 · 10th–90th $145–$3630%50%90th$145Professionalmedian $1,023 · 10th–90th $126–$1,2020%20%40%10th90th$1,023$100.0$200.0$500.0$1.0K$2.0K

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Small sample — interpret with caution. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$831.76 / $1,000.00 / $1,202.26
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$109.65 / $125.89 / $181.97
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$144.54 / $144.54 / $363.08
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$125.89 / $125.89 / $125.89
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,023.29 / $1,023.29 / $1,023.29
Martin's Point
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$831.76 / $1,000.00 / $1,202.26
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$125.89 / $239.88 / $1,023.29