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Maryland rates for HCPCS 15240

Full thickness graft, free, including direct closure of donor site, forehead, cheeks, chin, mouth, neck, axillae, genitalia, hands, and/or feet; 20 sq cm or less

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.98 / $1.00 / $4,432.35
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$691.22 / $857.77 / $2,118.96
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$794.83 / $881.63 / $1,013.87
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$754.25 / $931.15 / $1,581.27
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$965.15 / $1,246.52 / $2,119.77
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$450.00 / $450.00 / $450.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$725.10 / $952.14 / $1,848.56
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$744.47 / $882.29 / $1,115.26