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Idaho 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
$1,407.00 / $4,500.00 / $7,045.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$83.32 / $123.74 / $145.65
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$62.41 / $132.87 / $159.88
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$77.31 / $126.89 / $157.16
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$143.57 / $164.73 / $188.26
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.34 / $32.34 / $150.29
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$134.35 / $146.80 / $178.01
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,800.00 / $8,244.00 / $9,193.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$91.12 / $124.47 / $164.13