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Maine rates for HCPCS 15241

Full thickness graft, free, including direct closure of donor site, forehead, cheeks, chin, mouth, neck, axillae, genitalia, hands, and/or feet; each additional 20 sq cm, or part thereof (List separately in addition to code for primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$87.16 / $145.15 / $195.70
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$118.20 / $185.04 / $263.14
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$116.29 / $200.82 / $360.13
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$131.49 / $213.52 / $359.48
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$87.15 / $145.15 / $322.72
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$173.64 / $260.45 / $350.41