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Virginia 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
$155.10 / $2,561.00 / $8,294.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$245.42 / $245.42 / $245.42
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$158.47 / $175.15 / $208.51
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$131.84 / $165.66 / $256.51
Sentara
Facility/Professional
Facility
Modifier
Low / Median / High Price
$138.93 / $190.82 / $1,098.00
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$296.00 / $1,045.00 / $2,364.00