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Maine rates for HCPCS 15100

Split-thickness autograft, trunk, arms, legs; first 100 sq cm or less, or 1% of body area of infants and children (except 15050)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$569.37 / $1,650.96 / $5,792.04
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$569.37 / $753.07 / $1,395.55
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$763.10 / $916.63 / $1,389.54
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$681.86 / $1,178.75 / $1,713.84
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$893.65 / $1,096.86 / $1,815.46
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,650.96 / $1,650.96 / $5,792.04
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$569.37 / $785.28 / $1,372.15
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$853.74 / $1,179.56 / $1,740.96