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Maine rates for HCPCS Q4254

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

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$355.88 / $370.11 / $370.11
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$355.88 / $355.88 / $355.88
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$408.00 / $408.00 / $408.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$408.00 / $408.00 / $408.00
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$355.88 / $355.88 / $355.88
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$355.88 / $370.11 / $370.11
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$480.00 / $480.00 / $696.00