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Maine rates for HCPCS A2002

Mirragen Advanced Wound Matrix, per sq cm (add-on, list separately in addition to primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$102.33 / $128.82 / $181.97
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$95.50 / $125.89 / $181.97
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$302.00 / $302.00 / $302.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$147.91 / $147.91 / $302.00
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
$107.15 / $141.25 / $181.97
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$125.89 / $125.89 / $245.47