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Pennsylvania rates for HCPCS 15152

Tissue cultured skin autograft, trunk, arms, legs; each additional 100 sq cm, or each additional 1% of body area of infants and children, or part thereof (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
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,344.23 / $2,570.40 / $57,543.99
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$616.60 / $2,344.23 / $8,317.64
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$138.04 / $151.36 / $162.18
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$144.54 / $645.65 / $4,265.80