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Pennsylvania rates for HCPCS 15040

Harvest of skin for tissue cultured skin autograft, 100 sq cm or less

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$247.42 / $2,747.00 / $8,017.00
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,299.82 / $2,746.00 / $13,822.74
Highmark BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,797.00 / $4,797.00 / $4,797.00
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$918.00 / $3,120.00 / $8,017.00
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$213.81 / $213.81 / $213.81
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$120.55 / $159.90 / $254.29
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$814.00 / $2,391.00 / $6,000.00