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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

Facilitymedian $3,890 · 10th–90th $955–$8,3180%5%10%10th90th$3,890Professionalmedian $631 · 10th–90th $513–$1,0960%10%20%10th90th$631$200.0$1.0K$5.0K$20.0K

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$954.99 / $3,890.45 / $8,317.64
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$512.86 / $616.60 / $1,047.13
Capital Blue Cross
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$3,801.89 / $4,466.84 / $57,543.99
Capital Blue Cross
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$707.95 / $1,047.13 / $1,230.27
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$512.86 / $707.95 / $1,174.90
Emblem Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$794.33 / $1,202.26 / $1,318.26
Geisinger
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$616.60 / $870.96 / $1,288.25
Martin's Point
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$724.44 / $2,570.40 / $8,317.64
Martin's Point
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$501.19 / $616.60 / $1,096.48
Oscar Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$851.14 / $1,202.26 / $2,691.53
UPMC Health Plan
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$426.58 / $645.65 / $707.95
UPMC Health Plan
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$407.38 / $645.65 / $707.95
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,659.59 / $3,715.35 / $6,918.31
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$501.19 / $707.95 / $1,230.27