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Virginia 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
$723.72 / $3,633.00 / $8,294.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$606.10 / $714.25 / $793.46
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,060.00 / $3,693.00 / $4,290.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$600.67 / $764.17 / $1,077.45
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$673.24 / $673.24 / $15,962.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,084.92 / $1,084.92 / $1,084.92
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$605.42 / $785.43 / $1,401.60
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$730.90 / $815.70 / $971.08
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$604.29 / $776.01 / $1,125.16
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$845.00 / $963.00 / $1,482.70
Sentara
Facility/Professional
Facility
Modifier
Low / Median / High Price
$607.75 / $827.11 / $5,502.98
Sentara
Facility/Professional
Professional
Modifier
Low / Median / High Price
$639.76 / $885.71 / $5,502.98
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,629.00 / $2,819.00 / $5,764.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$560.21 / $740.32 / $1,268.08