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Maine rates for HCPCS A2016

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

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$72.44 / $91.20 / $128.82
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$107.15 / $125.89 / $186.21
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
$75.86 / $107.15 / $134.90
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$125.89 / $125.89 / $245.47