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Maine rates for HCPCS A2001

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

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,023.29 / $1,258.93 / $1,513.56
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$125.89 / $125.89 / $977.24
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,288.25 / $1,288.25 / $1,288.25
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,288.25 / $1,288.25 / $1,288.25
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$134.90 / $190.55 / $354.81
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,023.29 / $1,258.93 / $1,621.81
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$125.89 / $194.98 / $1,258.93