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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
$805.28 / $3,038.00 / $4,626.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$589.55 / $805.28 / $1,338.85
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$798.23 / $1,027.94 / $1,373.90
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$61.32 / $516.88 / $812.68
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,537.58 / $6,904.89 / $9,912.95
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$838.74 / $967.52 / $1,488.98
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,155.00 / $6,097.00 / $8,267.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$725.29 / $900.36 / $1,339.00