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Utah 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 $3,388 · 10th–90th $692–$4,8980%10%10th90th$3,388Professionalmedian $676 · 10th–90th $525–$1,2880%10%20%10th90th$676$50.0$100.0$200.0$500.0$1.0K$2.0K$5.0K

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
$691.83 / $3,388.44 / $4,897.79
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$524.81 / $645.65 / $1,096.48
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$660.69 / $831.76 / $1,122.02
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$32.36 / $33.11 / $2,454.71
Regence BlueShield
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$2,630.27 / $3,548.13 / $5,495.41
Regence BlueShield
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$660.69 / $912.01 / $1,445.44
Select Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$676.08 / $891.25 / $1,174.90
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$630.96 / $891.25 / $1,621.81
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$870.96 / $4,466.84 / $7,079.46
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$512.86 / $676.08 / $1,000.00