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Maine rates for HCPCS 15150

Tissue cultured skin autograft, trunk, arms, legs; first 25 sq cm or less

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$501.19 / $645.65 / $1,621.81
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$616.60 / $870.96 / $1,230.27
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$691.83 / $954.99 / $1,548.82
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$758.58 / $954.99 / $1,548.82
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$501.19 / $977.24 / $2,454.71
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$676.08 / $954.99 / $1,412.54