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Pennsylvania 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
$669.42 / $2,747.00 / $8,017.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$505.92 / $602.22 / $833.04
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,736.00 / $4,444.00 / $15,949.31
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$708.15 / $734.88 / $1,204.54
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$524.16 / $701.41 / $1,199.24
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$856.10 / $1,100.70 / $1,138.40
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$918.00 / $3,120.00 / $8,017.00
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$515.41 / $634.92 / $3,141.73
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$851.10 / $851.10 / $881.60
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,005.45 / $1,005.45 / $1,005.45
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$544.08 / $702.40 / $1,275.83
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$548.48 / $579.91 / $701.01
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$564.14 / $650.69 / $749.85
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,122.00 / $2,884.00 / $6,000.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$608.46 / $787.42 / $1,385.72