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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 / $54.95 / $3,981.07
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$645.65 / $933.25 / $2,238.72
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$758.58 / $831.76 / $977.24
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$707.95 / $933.25 / $1,621.81
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$891.25 / $1,122.02 / $2,089.30
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$446.68 / $446.68 / $707.95
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$660.69 / $912.01 / $1,659.59
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$741.31 / $1,000.00 / $1,548.82