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Maryland rates for HCPCS 15115

Epidermal Agrft F/S/N/H/F/G/M/D Gt 1st 100 Cm/<

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$685.72 / $707.28 / $816.20
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$743.74 / $796.14 / $915.56
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$658.46 / $842.70 / $1,365.98
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$841.37 / $1,091.43 / $1,831.72
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$450.00 / $450.00 / $450.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$659.43 / $815.02 / $1,522.82
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$636.05 / $765.65 / $972.98