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Pennsylvania rates for HCPCS 15116

Epidermal autograft, face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits; 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
$149.11 / $2,240.00 / $7,629.00
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,299.82 / $2,746.00 / $13,822.74
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$617.00 / $2,371.00 / $8,017.00
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$235.08 / $235.08 / $235.08
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$136.07 / $149.66 / $162.13
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$144.00 / $650.00 / $4,300.00