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Maine rates for HCPCS 15135

Dermal 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
Facility
Modifier
Low / Median / High Price
$3,890.45 / $3,890.45 / $3,890.45
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$602.56 / $831.76 / $1,995.26
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$707.95 / $1,071.52 / $1,445.44
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$831.76 / $1,148.15 / $1,949.84
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$831.76 / $1,122.02 / $1,778.28
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,890.45 / $3,890.45 / $3,890.45
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$602.56 / $1,202.26 / $3,019.95
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$831.76 / $1,122.02 / $1,737.80