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Pennsylvania 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

Facilitymedian $3,890 · 10th–90th $955–$8,3180%5%10%10th90th$3,890Professionalmedian $724 · 10th–90th $603–$1,2880%10%20%10th90th$724$200.0$1.0K$5.0K$20.0K

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$954.99 / $3,890.45 / $8,317.64
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$602.56 / $707.95 / $1,230.27
Capital Blue Cross
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$2,344.23 / $2,570.40 / $57,543.99
Capital Blue Cross
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$812.83 / $1,202.26 / $1,412.54
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$616.60 / $851.14 / $1,380.38
Emblem Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$891.25 / $1,348.96 / $1,479.11
Geisinger
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$758.58 / $1,023.29 / $1,445.44
Martin's Point
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$741.31 / $2,570.40 / $8,317.64
Martin's Point
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$602.56 / $724.44 / $1,584.89
Oscar Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$954.99 / $1,445.44 / $3,235.94
UPMC Health Plan
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$660.69 / $741.31 / $1,148.15
UPMC Health Plan
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$660.69 / $741.31 / $1,148.15
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,000.00 / $3,162.28 / $6,606.93
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$588.84 / $812.83 / $1,479.11