go back

Utah rates for HCPCS 15115

Epidermal Agrft F/S/N/H/F/G/M/D Gt 1st 100 Cm/<

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$797.62 / $3,038.00 / $4,626.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$582.53 / $747.97 / $1,228.20
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$727.61 / $1,023.72 / $1,278.11
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$61.32 / $463.11 / $731.44
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,814.80 / $3,509.81 / $5,038.84
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$771.21 / $897.41 / $1,381.46
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$871.00 / $4,455.00 / $4,912.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$685.20 / $824.29 / $1,324.72