go back

Utah rates for HCPCS 15135

Dermal autograft, face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits; 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
$912.01 / $3,388.44 / $4,897.79
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$660.69 / $812.83 / $1,348.96
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$741.31 / $1,047.13 / $1,380.38
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $33.11 / $3,019.95
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,888.44 / $6,918.31 / $13,803.84
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$831.76 / $1,174.90 / $1,949.84
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$812.83 / $1,071.52 / $1,621.81
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$933.25 / $1,148.15 / $2,089.30
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,137.96 / $5,128.61 / $8,317.64
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$645.65 / $831.76 / $1,258.93