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Maine rates for HCPCS A2015

Phoenix 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
$73.80 / $77.55 / $95.38
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$51.83 / $59.38 / $59.38
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$785.24 / $785.24 / $785.24
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$76.34 / $77.55 / $81.09
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,438.66 / $1,438.66 / $2,157.98