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Maine 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
$3,090.30 / $3,467.37 / $7,943.28
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$630.96 / $954.99 / $2,238.72
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$758.58 / $1,122.02 / $1,513.56
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$812.83 / $1,202.26 / $2,089.30
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$870.96 / $1,148.15 / $1,819.70
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,090.30 / $3,467.37 / $7,943.28
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$630.96 / $1,023.29 / $2,344.23
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$812.83 / $1,202.26 / $1,819.70