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Maine rates for HCPCS 14021

Adjacent tissue transfer or rearrangement, scalp, arms and/or legs; defect 10.1 sq cm to 30.0 sq cm

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,786.30 / $5,370.32 / $5,623.41
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$616.60 / $891.25 / $1,949.84
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$691.83 / $1,047.13 / $1,412.54
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$794.33 / $1,071.52 / $1,949.84
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$776.25 / $1,096.48 / $1,698.24
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,786.30 / $5,370.32 / $5,623.41
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$616.60 / $977.24 / $2,454.71
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$776.25 / $1,096.48 / $1,698.24