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Maine rates for HCPCS 15220

Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; 20 sq cm or less

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$616.66 / $1,120.50 / $2,377.09
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$488.11 / $624.53 / $1,145.76
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$656.79 / $819.97 / $1,204.39
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$603.03 / $998.06 / $1,529.96
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$760.51 / $966.70 / $1,611.42
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,120.50 / $1,555.96 / $11,926.12
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$488.11 / $664.94 / $1,145.76
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$769.83 / $1,058.65 / $1,559.66