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Maine rates for HCPCS Q4235

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

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$87.98 / $91.50 / $91.50
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$87.98 / $87.98 / $87.98
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$87.98 / $87.98 / $87.98
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$87.98 / $87.98 / $87.98
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$87.98 / $87.98 / $87.98
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$87.98 / $91.50 / $91.50
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$87.98 / $87.98 / $127.57