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Maine rates for HCPCS 15135

Dermal Autograft F/S/N/H/F/G/M/D Gt 1st 100

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,891.10 / $3,891.10 / $3,891.10
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$604.98 / $698.39 / $698.39
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$774.69 / $958.16 / $1,445.29
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$688.27 / $1,169.25 / $1,732.72
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$943.53 / $1,158.08 / $1,821.00
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,891.10 / $3,891.10 / $3,891.10
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$604.98 / $604.98 / $698.39
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$716.47 / $1,171.14 / $1,754.93