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Idaho rates for HCPCS 15110

Epidermal autograft, trunk, arms, legs; first 100 sq cm or less, or 1% of body area of infants and children

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,628.00 / $4,500.00 / $7,205.00
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$623.16 / $1,071.04 / $1,365.52
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,074.61 / $4,697.79 / $5,755.74
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,450.00 / $6,124.00 / $7,609.00