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Maine rates for HCPCS 15115

Epidermal autograft, face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits; first 100 sq cm or less, or 1% of body area of infants and children

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$547.17 / $637.16 / $637.16
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$715.61 / $878.23 / $1,328.94
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$628.60 / $1,083.54 / $1,580.81
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$872.63 / $1,071.07 / $1,700.25
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$547.17 / $547.17 / $637.16
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$773.17 / $1,143.41 / $1,620.05