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California rates for HCPCS 15004

Surgical preparation or creation of recipient site by excision of open wounds, burn eschar, or scar (including subcutaneous tissues), or incisional release of scar contracture, face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet and/or multiple digits; first 100 sq cm or 1% of body area of infants and children

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$557.82 / $5,153.00 / $16,125.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$233.74 / $362.86 / $1,020.15
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,202.03 / $1,202.03 / $1,202.03
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,143.00 / $5,849.00 / $11,400.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$238.92 / $368.11 / $826.18
Blue Shield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$66.00 / $100.00 / $6,881.37
Blue Shield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$227.72 / $344.85 / $709.84
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$262.61 / $404.72 / $742.43
Contra Costa Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$289.58 / $390.02 / $564.53
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$260.32 / $411.34 / $736.79
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,775.40 / $1,804.02 / $16,394.00
Lucent Health
Facility/Professional
Facility
Modifier
AS
Low / Median / High Price
$118.23 / $127.70 / $127.70
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,884.56 / $2,824.64 / $3,286.43
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.34 / $32.34 / $32.34
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$253.41 / $373.79 / $588.27
Providence
Facility/Professional
Facility
Modifier
AS
Low / Median / High Price
$128.97 / $128.97 / $128.97
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$265.50 / $421.42 / $787.44
Sutter Health Plus
Facility/Professional
Professional
Modifier
Low / Median / High Price
$862.23 / $862.23 / $1,317.84
The Alliance
Facility/Professional
Professional
Modifier
Low / Median / High Price
$233.77 / $380.07 / $522.60
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$587.00 / $1,523.00 / $5,691.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$308.49 / $394.73 / $885.16