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Maine 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
$10,471.29 / $10,471.29 / $10,471.29
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$707.95 / $933.25 / $2,344.23
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$794.33 / $1,202.26 / $1,621.81
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$891.25 / $1,288.25 / $2,290.87
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$891.25 / $1,230.27 / $1,949.84
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$10,471.29 / $10,471.29 / $10,471.29
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$724.44 / $1,096.48 / $2,454.71
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$870.96 / $1,318.26 / $1,949.84