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Connecticut 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
$845.40 / $4,722.42 / $8,031.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$494.31 / $711.80 / $1,442.95
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,315.00 / $4,735.00 / $11,908.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$571.54 / $991.96 / $1,599.01
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$646.39 / $911.81 / $1,439.38
ConnectiCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$706.60 / $831.29 / $868.40
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,565.00 / $7,010.00 / $11,152.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$643.94 / $893.37 / $1,430.38