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Florida rates for HCPCS 15136

Dermal autograft, face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits; each additional 100 sq cm, or each additional 1% of body area of infants and children, or part thereof (List separately in addition to code for primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$78.73 / $3,258.00 / $10,802.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$68.29 / $81.92 / $113.60
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$323.00 / $323.00 / $323.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$73.18 / $98.93 / $154.79
Florida Blue
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,144.00 / $2,674.00 / $6,696.00
Florida Blue
Facility/Professional
Professional
Modifier
Low / Median / High Price
$44.00 / $75.77 / $115.92
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$74.37 / $103.47 / $138.91
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$366.00 / $1,950.00 / $4,970.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$68.44 / $90.55 / $152.30
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$67.61 / $71.18 / $71.18