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Illinois 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
$174.60 / $1,758.00 / $5,393.00
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$588.71 / $1,259.28 / $2,521.69
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$709.00 / $709.00 / $735.00
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$138.91 / $258.30 / $871.14
Hally Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $100.00 / $100.00
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$165.00 / $963.00 / $3,686.00