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Maine 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
$64.57 / $89.13 / $223.87
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$85.11 / $123.03 / $169.82
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$95.50 / $138.04 / $223.87
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$93.33 / $128.82 / $199.53
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$72.44 / $128.82 / $346.74
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$93.33 / $131.83 / $194.98