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Maine rates for HCPCS A2009

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

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$52.48 / $67.61 / $102.33
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
$93.33 / $93.33 / $93.33
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$93.33 / $93.33 / $93.33
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
$57.54 / $75.86 / $131.83
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$91.20 / $125.89 / $245.47