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Maine rates for HCPCS 15261

Full thickness graft, free, including direct closure of donor site, nose, ears, eyelids, and/or lips; 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
$110.08 / $168.08 / $168.08
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$149.05 / $224.88 / $310.52
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$150.84 / $254.64 / $417.00
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$166.12 / $254.37 / $424.01
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$110.08 / $110.08 / $168.08
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$201.27 / $297.11 / $412.16