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Rhode Island 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
$2,089.30 / $2,630.27 / $3,981.07
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$588.84 / $912.01 / $2,089.30
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$537.03 / $741.31 / $1,230.27
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$758.58 / $1,071.52 / $1,819.70
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,819.70 / $4,073.80 / $6,165.95
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$588.84 / $1,023.29 / $1,621.81