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Ohio rates for HCPCS 15131

Dermal autograft, trunk, arms, legs; 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
$95.50 / $2,570.40 / $10,715.19
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$77.62 / $91.20 / $323.59
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$707.95 / $1,905.46 / $2,511.89
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$83.18 / $107.15 / $173.78
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$87.10 / $87.10 / $87.10
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$21,379.62 / $21,379.62 / $21,379.62
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$83.18 / $117.49 / $194.98
Medical Mutual of Ohio
Facility/Professional
Facility
Modifier
Low / Median / High Price
$21,379.62 / $21,379.62 / $21,379.62
Medical Mutual of Ohio
Facility/Professional
Professional
Modifier
Low / Median / High Price
$81.28 / $120.23 / $186.21
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $33.11 / $75.86
SummaCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $100.00 / $100.00
SummaCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$77.62 / $109.65 / $199.53
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$457.09 / $954.99 / $3,019.95
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$75.86 / $100.00 / $162.18