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Virginia 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
$171.29 / $2,561.00 / $8,294.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$235.08 / $235.08 / $235.08
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$158.44 / $175.12 / $208.48
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$133.94 / $179.08 / $259.06
Sentara
Facility/Professional
Facility
Modifier
Low / Median / High Price
$141.88 / $191.26 / $1,098.00
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$296.00 / $1,045.00 / $2,364.00