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Iowa 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
$3,468.00 / $4,917.20 / $8,042.03
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$106.52 / $247.76 / $588.04
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$163.59 / $293.76 / $1,607.00
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$240.91 / $345.19 / $589.22
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,204.00 / $1,623.00 / $2,126.00