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Maine 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
Professional
Modifier
Low / Median / High Price
$159.94 / $248.79 / $487.12
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$217.07 / $327.72 / $463.30
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$217.39 / $362.02 / $617.24
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$238.66 / $375.93 / $632.91
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$159.94 / $248.79 / $496.84
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$295.77 / $408.93 / $618.04