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Virginia 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
$213.40 / $3,633.00 / $8,294.00
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,060.00 / $3,693.00 / $4,290.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$213.81 / $213.81 / $213.81
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$271.98 / $307.11 / $365.61
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$119.30 / $235.14 / $367.03
Sentara
Facility/Professional
Facility
Modifier
Low / Median / High Price
$121.32 / $169.53 / $3,123.00
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,911.00 / $3,175.00 / $5,340.00