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Maine rates for HCPCS 15274

Application of skin substitute graft to trunk, arms, legs, total wound surface area greater than or equal to 100 sq cm; each additional 100 sq cm wound surface area, or part thereof, or each additional 1% of body area of infants and children, or part thereof (List separately in addition to code for primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$36.11 / $62.71 / $128.06
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$49.44 / $76.98 / $120.90
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$49.64 / $89.59 / $156.21
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$54.00 / $95.84 / $165.16
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$36.11 / $62.96 / $128.06
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$75.38 / $102.52 / $174.12