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Virginia 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
$775.09 / $3,633.00 / $8,294.00
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,060.00 / $3,693.00 / $4,290.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,211.27 / $1,211.27 / $1,211.27
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$864.96 / $960.09 / $1,142.96
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$678.96 / $881.32 / $1,318.12
Sentara
Facility/Professional
Facility
Modifier
Low / Median / High Price
$682.75 / $923.62 / $3,320.60
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,911.00 / $3,175.00 / $5,340.00