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California rates for HCPCS 15150

Tissue cultured skin autograft, trunk, arms, legs; first 25 sq cm or less

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$653.37 / $5,382.00 / $16,713.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$529.19 / $615.30 / $3,292.63
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,894.00 / $4,734.00 / $9,589.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$523.36 / $690.90 / $1,397.19
Blue Shield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$66.00 / $100.00 / $6,881.37
Blue Shield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$437.47 / $624.95 / $1,475.54
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$603.04 / $779.00 / $1,615.06
Contra Costa Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$552.12 / $799.99 / $962.87
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$619.62 / $836.49 / $1,462.36
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,965.40 / $3,149.11 / $16,394.00
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,540.72 / $5,127.12 / $6,067.88
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.34 / $32.34 / $32.34
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$587.57 / $802.66 / $1,082.51
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$622.57 / $811.84 / $1,656.72
Sutter Health Plus
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,043.02 / $2,043.02 / $2,266.62
The Alliance
Facility/Professional
Professional
Modifier
Low / Median / High Price
$575.10 / $790.77 / $1,044.40
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,300.00 / $4,099.00 / $9,476.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$547.10 / $730.80 / $1,702.08