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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
$3,055.50 / $3,458.76 / $7,929.11
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$636.01 / $809.94 / $1,514.91
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$842.94 / $1,027.35 / $1,520.97
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$726.97 / $1,289.30 / $1,846.57
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$992.99 / $1,218.80 / $1,948.01
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,458.76 / $3,458.76 / $7,929.11
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$636.00 / $856.37 / $1,553.44
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$893.06 / $1,285.73 / $2,087.76