go back

Maine 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
Professional
Modifier
Low / Median / High Price
$72.98 / $78.14 / $78.14
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$89.09 / $115.30 / $168.49
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$74.23 / $138.60 / $193.86
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$110.88 / $136.09 / $201.95
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$72.98 / $72.98 / $78.14
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$95.39 / $132.11 / $189.48