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Maine rates for HCPCS 15278

Application of skin substitute graft to face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits, 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
Facility
Modifier
Low / Median / High Price
$891.41 / $891.41 / $891.41
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$45.61 / $59.56 / $74.18
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$61.70 / $96.88 / $143.26
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$62.20 / $109.90 / $184.03
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$68.84 / $116.24 / $195.70
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$891.41 / $891.41 / $891.41
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$45.61 / $59.56 / $106.61
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$84.39 / $118.66 / $208.08