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Maine rates for HCPCS 15275

Application of skin substitute graft to face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits, 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
$76.59 / $4,236.37 / $4,792.60
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$76.61 / $126.03 / $257.86
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$101.85 / $162.41 / $241.81
Anthem BCBS
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$152.77 / $243.63 / $362.71
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$103.79 / $181.74 / $312.69
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$115.42 / $196.21 / $330.34
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.94 / $3,405.78 / $4,792.60
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$76.61 / $126.39 / $252.33
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$151.37 / $206.81 / $353.52