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Maryland rates for HCPCS 15200

Full thickness graft, free, including direct closure of donor site, trunk; 20 sq cm or less

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,424.34 / $1,424.34 / $2,897.49
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$665.27 / $825.36 / $1,971.14
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$659.23 / $732.47 / $842.34
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$636.04 / $817.75 / $1,427.29
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$870.51 / $1,077.78 / $1,926.70
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$950.00 / $950.00 / $950.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$610.21 / $845.97 / $1,581.53
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$663.45 / $744.61 / $1,009.56