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Utah rates for HCPCS 15130

Dermal Autograft Trunk/Arm/Leg 1st 100 Cm

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$591.62 / $3,038.00 / $4,626.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$432.48 / $591.62 / $1,095.22
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$644.33 / $820.07 / $1,129.16
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$61.16 / $408.63 / $667.53
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,814.80 / $3,509.81 / $5,038.84
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$663.09 / $799.25 / $1,126.76
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,981.00 / $3,613.00 / $7,048.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$583.11 / $742.64 / $1,052.13