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Maryland rates for HCPCS 15131

Dermal autograft, trunk, arms, legs; each additional 100 sq cm, or each additional 1% of body area of infants and children, or part thereof (List separately in addition to code for primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$89.08 / $89.37 / $98.06
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$92.85 / $97.76 / $112.42
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.11 / $101.25 / $170.90
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$101.19 / $131.76 / $232.79
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$150.00 / $150.00 / $150.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$80.00 / $102.41 / $223.73
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$71.76 / $96.95 / $117.46