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Rhode Island 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
$1,518.41 / $1,543.03 / $3,955.04
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$64.90 / $85.20 / $92.00
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$78.55 / $100.17 / $142.80
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$90.77 / $110.01 / $193.80
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$540.00 / $1,401.00 / $4,915.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.40 / $121.06 / $186.36