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Ohio 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
$157.72 / $3,907.00 / $9,863.00
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$891.00 / $2,170.00 / $5,211.00
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$106.12 / $154.51 / $154.51
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$21,571.00 / $21,571.00 / $21,571.00
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$444.00 / $975.00 / $2,914.00