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Maryland 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
$459.82 / $1,885.73 / $7,578.85
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$711.68 / $877.30 / $1,925.20
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$727.98 / $783.21 / $900.69
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$684.46 / $877.14 / $1,503.17
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$898.56 / $1,127.60 / $2,001.28
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$450.00 / $450.00 / $450.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$670.73 / $874.04 / $1,715.19
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$685.04 / $791.19 / $1,044.15