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Maryland rates for HCPCS 15201

Full thickness graft, free, including direct closure of donor site, trunk; each additional 20 sq cm, or part thereof (List separately in addition to code for primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,424.33 / $1,424.33 / $2,897.49
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$130.94 / $176.63 / $342.10
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$150.00 / $150.00 / $150.00