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Utah 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
$138.04 / $3,162.28 / $4,570.88
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$95.50 / $117.49 / $239.88
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$109.65 / $147.91 / $181.97
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $33.11 / $199.53
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$120.23 / $169.82 / $204.17
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$112.20 / $151.36 / $213.80
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$128.82 / $162.18 / $213.80
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,071.52 / $4,466.84 / $5,128.61
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$93.33 / $120.23 / $177.83