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Pennsylvania rates for HCPCS 15151

Tissue cultured skin autograft, trunk, arms, legs; additional 1 sq cm to 75 sq cm (List separately in addition to code for primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$724.44 / $2,691.53 / $8,317.64
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$93.33 / $109.65 / $295.12
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,344.23 / $2,570.40 / $57,543.99
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$117.49 / $199.53 / $234.42
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$100.00 / $128.82 / $208.93
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$154.88 / $199.53 / $218.78
Geisinger
Facility/Professional
Professional
Modifier
Low / Median / High Price
$114.82 / $165.96 / $245.47
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$616.60 / $2,344.23 / $8,317.64
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$95.50 / $131.83 / $407.38
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$107.15 / $114.82 / $131.83
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$66.07 / $109.65 / $177.83
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$144.54 / $645.65 / $4,265.80
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$95.50 / $128.82 / $223.87