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California rates for HCPCS 15111

Epidermal 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
$108.53 / $4,848.00 / $16,125.00
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,787.00 / $4,539.00 / $9,381.00
Blue Shield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$65.80 / $100.00 / $5,238.60
Contra Costa Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$103.87 / $124.08 / $155.81
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$95.98 / $127.97 / $257.00
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$461.73 / $483.03 / $12,000.00
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$95.19 / $129.18 / $170.67
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$587.00 / $1,551.00 / $6,323.00