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Maine rates for HCPCS 15130

Dermal autograft, trunk, arms, legs; 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
$476.39 / $576.09 / $576.09
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$609.41 / $745.42 / $1,142.64
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$568.89 / $906.14 / $1,429.29
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$748.14 / $918.27 / $1,505.24
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$476.39 / $476.39 / $576.09
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$690.12 / $924.71 / $1,586.87