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Pennsylvania 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
$176.00 / $2,747.00 / $7,629.00
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,058.35 / $6,182.00 / $17,094.48
Highmark BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,147.05 / $2,147.05 / $4,903.96
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$655.00 / $3,748.00 / $8,017.00
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$186.21 / $186.21 / $186.21
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$107.59 / $133.61 / $204.81
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$144.00 / $650.00 / $4,300.00