go back

Maryland rates for HCPCS 15130

Dermal Autograft Trunk/Arm/Leg 1st 100 Cm

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$561.37 / $611.04 / $749.71
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$585.50 / $618.63 / $711.42
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$572.64 / $711.49 / $1,211.58
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$745.43 / $943.61 / $1,675.72
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$950.00 / $950.00 / $1,628.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$546.54 / $725.81 / $1,457.68
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$532.87 / $665.86 / $865.37