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Idaho rates for HCPCS 15155

Tissue cultured skin autograft, face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits; first 25 sq cm or less

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,628.00 / $4,500.00 / $7,205.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$685.30 / $1,043.31 / $1,206.59
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$516.29 / $1,071.58 / $1,287.18
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$623.79 / $1,043.31 / $1,299.15
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,179.52 / $1,354.16 / $1,554.58
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.34 / $32.34 / $1,240.34
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,960.99 / $8,854.77 / $10,870.07
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,108.30 / $1,220.95 / $1,481.12
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$9,360.00 / $16,762.00 / $17,870.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$708.40 / $969.13 / $1,337.49