go back

Maine 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
$3,019.95 / $3,019.95 / $3,019.95
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$537.03 / $724.44 / $1,698.24
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$676.08 / $977.24 / $1,380.38
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$676.08 / $1,023.29 / $1,905.46
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$741.31 / $1,096.48 / $1,698.24
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,019.95 / $3,019.95 / $3,019.95
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$549.54 / $933.25 / $2,290.87
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$724.44 / $1,096.48 / $1,698.24