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Georgia rates for HCPCS 15101

Split-thickness autograft, trunk, arms, legs; 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
Facility
Modifier
Low / Median / High Price
$166.00 / $4,733.00 / $6,915.00
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$822.79 / $1,791.76 / $3,132.87
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$119.43 / $197.82 / $309.52
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$353.00 / $1,580.00 / $2,665.00