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Maryland rates for HCPCS 15260

Full thickness graft, free, including direct closure of donor site, nose, ears, eyelids, and/or lips; 20 sq cm or less

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$430.41 / $1,171.18 / $6,053.61
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$747.71 / $898.20 / $2,214.90
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$847.27 / $941.41 / $1,082.61
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$801.64 / $996.64 / $1,708.97
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,039.55 / $1,320.66 / $2,262.60
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$450.00 / $450.00 / $450.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$767.31 / $1,018.17 / $2,147.02
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$807.02 / $934.39 / $1,198.97