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Maryland 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
$1,583.12 / $1,583.12 / $1,839.28
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$174.27 / $234.83 / $447.04
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$150.00 / $150.00 / $150.00