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Connecticut rates for HCPCS 15100

Split-thickness autograft, trunk, arms, legs; first 100 sq cm or less, or 1% of body area of infants and children (except 15050)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,086.63 / $4,664.00 / $7,629.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$627.70 / $916.88 / $1,831.77
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,788.00 / $6,273.00 / $10,956.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$688.82 / $974.97 / $1,259.64
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$772.19 / $1,169.79 / $1,828.07
ConnectiCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$901.77 / $1,060.90 / $1,108.26
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,414.00 / $5,950.00 / $9,338.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$773.18 / $1,071.51 / $1,737.59