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Maryland rates for HCPCS 15273

Application of skin substitute graft to trunk, arms, legs, total wound surface area greater than or equal to 100 sq cm; first 100 sq cm wound surface area, or 1% of body area of infants and children

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$17,857.22 / $17,857.22 / $17,857.22
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$193.81 / $289.66 / $520.50
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$220.01 / $220.01 / $279.41
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$182.13 / $292.20 / $510.80
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$300.06 / $387.91 / $730.29
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,028.00 / $1,028.00 / $1,028.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$257.82 / $321.47 / $558.29
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$207.47 / $253.76 / $363.57