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Maine rates for HCPCS 15276

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; each additional 25 sq cm wound surface area, or part thereof (List separately in addition to code for primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$20.62 / $20.62 / $27.19
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20.62 / $27.19 / $45.51
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$27.13 / $36.43 / $52.42
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$25.47 / $42.79 / $67.45
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.50 / $40.79 / $68.02
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20.62 / $27.19 / $51.89
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$33.39 / $47.98 / $71.70