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Pennsylvania 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)

Facilitymedian $2,692 · 10th–90th $617–$8,3180%5%10%10th90th$2,692Professionalmedian $85 · 10th–90th $76–$1660%20%40%10th90th$85$20.0$100.0$500.0$2.0K$10.0K$50.0K

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$724.44 / $2,691.53 / $8,317.64
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$75.86 / $85.11 / $158.49
Capital Blue Cross
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$3,801.89 / $4,466.84 / $57,543.99
Capital Blue Cross
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$95.50 / $141.25 / $181.97
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$81.28 / $102.33 / $169.82
Emblem Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$104.71 / $158.49 / $173.78
Geisinger
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$93.33 / $123.03 / $169.82
Martin's Point
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$537.03 / $1,905.46 / $6,606.93
Martin's Point
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$75.86 / $85.11 / $165.96
Oscar Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$107.15 / $218.78 / $741.31
UPMC Health Plan
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$18.62 / $89.13 / $95.50
UPMC Health Plan
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$36.31 / $87.10 / $95.50
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$162.18 / $630.96 / $4,466.84
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$72.44 / $102.33 / $181.97