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Connecticut rates for HCPCS 15115

Epidermal autograft, face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits; 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
$1,007.42 / $4,722.42 / $8,031.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$619.77 / $877.93 / $1,707.45
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,315.00 / $4,735.00 / $11,908.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$660.56 / $1,147.42 / $2,048.42
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$737.69 / $1,087.69 / $1,668.68
ConnectiCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$897.74 / $1,056.16 / $1,103.31
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,120.00 / $5,950.00 / $9,338.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$705.76 / $953.17 / $1,567.69