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Virginia 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
$116.99 / $2,561.00 / $8,294.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$173.66 / $173.66 / $173.66
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$117.65 / $130.03 / $154.80
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$97.40 / $124.01 / $191.12
Sentara
Facility/Professional
Facility
Modifier
Low / Median / High Price
$102.58 / $135.34 / $1,098.00
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$296.00 / $1,045.00 / $2,364.00