go back

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
$398.11 / $1,047.13 / $6,025.60
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$724.44 / $1,023.29 / $2,570.40
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$794.33 / $891.25 / $1,023.29
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$758.58 / $1,000.00 / $1,737.80
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$954.99 / $1,174.90 / $2,187.76
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$446.68 / $446.68 / $707.95
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$707.95 / $977.24 / $1,778.28
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$812.83 / $1,071.52 / $1,621.81