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Georgia 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
$697.41 / $3,295.00 / $6,915.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$592.05 / $750.65 / $1,439.88
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$964.00 / $2,354.21 / $5,240.56
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$691.15 / $967.21 / $1,695.92
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$577.82 / $852.56 / $1,566.41
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$760.27 / $878.39 / $1,931.34
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,001.77 / $1,181.83 / $1,408.26
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,269.00 / $3,218.00 / $5,352.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$731.28 / $1,056.61 / $1,828.90