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Maine rates for HCPCS 15157

Tissue cultured skin 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
$130.43 / $141.00 / $141.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$163.34 / $211.38 / $309.66
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$135.61 / $247.65 / $349.82
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$201.98 / $247.91 / $370.58
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$130.43 / $130.43 / $141.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$201.98 / $244.57 / $343.17