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Pennsylvania 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
$954.99 / $3,890.45 / $8,317.64
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$645.65 / $794.33 / $2,041.74
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,801.89 / $4,466.84 / $57,543.99
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$870.96 / $1,348.96 / $1,584.89
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$691.83 / $870.96 / $1,445.44
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,096.48 / $1,412.54 / $1,548.82
Geisinger
Facility/Professional
Professional
Modifier
Low / Median / High Price
$794.33 / $1,071.52 / $1,584.89
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$912.01 / $2,691.53 / $8,317.64
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$660.69 / $891.25 / $2,454.71
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$416.87 / $741.31 / $891.25
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$691.83 / $831.76 / $891.25
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,089.30 / $3,981.07 / $10,964.78
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$645.65 / $870.96 / $1,548.82