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Pennsylvania 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
$766.73 / $2,747.00 / $8,017.00
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,299.82 / $2,746.00 / $13,822.74
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$918.00 / $3,120.00 / $8,017.00
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,211.27 / $1,211.27 / $1,211.27
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$687.44 / $696.18 / $812.21
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$637.00 / $2,391.00 / $6,000.00