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Utah rates for HCPCS 15101

Split-thickness 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)

Facilitymedian $4,571 · 10th–90th $191–$8,5110%10%10th90th$4,571Professionalmedian $224 · 10th–90th $123–$3800%10%10th90th$224$100.0$200.0$500.0$1.0K$2.0K$5.0K$10.0K

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
$190.55 / $4,570.88 / $8,511.38
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$123.03 / $223.87 / $380.19
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$660.69 / $4,466.84 / $5,128.61