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Maine rates for HCPCS 15221

Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; 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
$1,122.02 / $1,122.02 / $1,122.02
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$56.23 / $107.15 / $218.78
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$77.62 / $123.03 / $208.93
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$77.62 / $151.36 / $281.84
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$70.79 / $141.25 / $257.04
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,122.02 / $1,122.02 / $1,122.02
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$56.23 / $131.83 / $371.54
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$70.79 / $128.82 / $229.09