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California rates for HCPCS 15130

Dermal autograft, trunk, arms, legs; first 100 sq cm or less, or 1% of body area of infants and children

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$663.30 / $5,382.00 / $16,713.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$467.44 / $574.91 / $3,141.73
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,143.00 / $5,931.00 / $11,456.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$475.50 / $640.21 / $1,399.87
Blue Shield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$66.00 / $100.00 / $6,881.37
Blue Shield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$439.59 / $627.98 / $1,363.45
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$553.90 / $759.29 / $1,488.92
Contra Costa Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$557.33 / $836.00 / $1,045.76
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$599.77 / $833.90 / $1,431.43
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,796.08 / $3,046.94 / $16,394.00
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,326.32 / $5,170.88 / $6,114.98
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.34 / $32.34 / $32.34
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$555.14 / $783.69 / $1,136.16
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$563.19 / $805.19 / $1,582.26
Sutter Health Plus
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,949.39 / $1,949.39 / $2,368.94
The Alliance
Facility/Professional
Professional
Modifier
Low / Median / High Price
$572.46 / $787.13 / $1,054.26
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,842.00 / $7,454.00 / $15,471.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$536.38 / $701.42 / $1,627.23