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Maine rates for HCPCS Q4256

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

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$735.05 / $764.45 / $764.45
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$735.05 / $735.05 / $808.55
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$735.05 / $735.05 / $735.05
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$735.05 / $735.05 / $735.05
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$735.05 / $735.05 / $735.05
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$735.05 / $764.45 / $764.45
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$735.05 / $735.05 / $1,065.82