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Pennsylvania 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
$805.31 / $2,747.00 / $8,017.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$655.12 / $756.31 / $1,050.48
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,736.00 / $4,444.00 / $15,949.31
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$861.53 / $894.04 / $1,529.44
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$690.84 / $873.17 / $1,554.57
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,027.10 / $1,320.57 / $1,362.14
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$918.00 / $3,120.00 / $8,017.00
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$655.50 / $805.31 / $3,980.51
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,278.85 / $1,278.85 / $1,278.85
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$709.87 / $890.38 / $1,629.44
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$706.92 / $739.96 / $856.63
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$719.17 / $791.10 / $910.78
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,440.00 / $3,475.00 / $6,368.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$744.30 / $959.35 / $1,682.65