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Michigan 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
$1,023.29 / $2,884.03 / $4,897.79
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$630.96 / $794.33 / $1,445.44
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$707.95 / $707.95 / $1,148.15
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$229.09 / $1,148.15 / $1,148.15
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$630.96 / $912.01 / $3,467.37
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$954.99 / $2,884.03 / $4,897.79
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$691.83 / $954.99 / $1,258.93
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$630.96 / $831.76 / $3,162.28
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,884.03 / $5,888.44 / $10,000.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$741.31 / $912.01 / $1,230.27