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Maine rates for HCPCS A6025

Gel sheet for dermal or epidermal application, (e.g., silicone, hydrogel, other), each

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.21 / $12.23 / $14.55
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.78 / $4.78 / $5.25
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.47 / $13.47 / $13.47
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$26.54 / $26.54 / $26.54
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.34 / $12.23 / $12.23
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.09 / $21.32 / $26.54