go back

Maine rates for HCPCS A2005

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

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$176.02 / $184.94 / $227.47
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.10 / $4.38 / $112.60
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$216.38 / $216.38 / $216.38
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$182.08 / $184.94 / $193.40
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$254.57 / $254.57 / $369.13