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Colorado 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
$1,226.00 / $4,955.00 / $10,651.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$521.52 / $623.12 / $773.47
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,434.00 / $5,126.00 / $9,729.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$691.49 / $917.66 / $1,414.22
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$614.92 / $788.50 / $1,091.48
Denver HMP
Facility/Professional
Facility
Modifier
Low / Median / High Price
$628.37 / $804.73 / $1,034.96
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$716.59 / $943.51 / $1,421.11
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,645.00 / $6,090.00 / $14,057.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$741.38 / $923.22 / $1,607.96