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Utah rates for HCPCS 15100

Split-thickness autograft, trunk, arms, legs; first 100 sq cm or less, or 1% of body area of infants and children (except 15050)

Facilitymedian $3,388 · 10th–90th $891–$4,7860%10%20%10th90th$3,388Professionalmedian $871 · 10th–90th $603–$2,3990%10%10th90th$871$50.0$100.0$200.0$500.0$1.0K$2.0K$5.0K

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$891.25 / $3,388.44 / $4,570.88
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$588.84 / $870.96 / $2,398.83
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$812.83 / $1,047.13 / $1,380.38
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$32.36 / $33.11 / $1,862.09
Regence BlueShield
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$2,630.27 / $3,548.13 / $5,495.41
Regence BlueShield
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$794.33 / $1,096.48 / $1,659.59
Select Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$812.83 / $1,071.52 / $1,513.56
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$676.08 / $1,071.52 / $1,479.11
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$870.96 / $4,466.84 / $5,128.61
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$630.96 / $812.83 / $1,230.27