go back

Rhode Island 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
$2,090.73 / $2,778.87 / $3,955.04
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$536.63 / $647.76 / $903.43
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$620.95 / $848.04 / $1,262.10
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$727.71 / $905.73 / $1,637.87
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,806.00 / $3,465.00 / $5,510.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$604.83 / $1,021.54 / $1,475.15