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Maine rates for HCPCS 15271

Application of skin substitute graft to trunk, arms, legs, total wound surface area up to 100 sq cm; first 25 sq cm or less wound surface area

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,819.70 / $2,511.89 / $9,772.37
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$69.18 / $120.23 / $239.88
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$91.20 / $144.54 / $245.47
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$95.50 / $181.97 / $338.84
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$93.33 / $165.96 / $302.00
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,819.70 / $2,511.89 / $9,772.37
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$72.44 / $123.03 / $257.04
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$93.33 / $165.96 / $275.42