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Virginia 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
$117.49 / $2,570.40 / $7,079.46
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$93.33 / $112.20 / $223.87
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$107.15 / $147.91 / $208.93
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$112.20 / $776.25 / $1,047.13
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$186.21 / $186.21 / $1,318.26
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$102.33 / $141.25 / $229.09
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$109.65 / $144.54 / $173.78
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$186.21 / $186.21 / $229.09
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $134.90 / $213.80
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$97.72 / $97.72 / $97.72
Sentara
Facility/Professional
Facility
Modifier
Low / Median / High Price
$102.33 / $151.36 / $4,073.80
Sentara
Facility/Professional
Professional
Modifier
Low / Median / High Price
$117.49 / $165.96 / $4,073.80
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$229.09 / $1,202.26 / $2,454.71
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$91.20 / $128.82 / $218.78