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Pennsylvania 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
$732.46 / $2,747.00 / $8,017.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$569.00 / $689.98 / $894.66
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,299.82 / $2,746.00 / $13,822.74
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$789.03 / $818.81 / $1,445.64
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$632.71 / $794.77 / $1,412.38
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$948.14 / $1,219.04 / $1,261.52
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$918.00 / $3,120.00 / $8,017.00
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$618.44 / $732.46 / $3,860.40
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,231.81 / $1,231.81 / $1,231.81
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$641.37 / $803.98 / $1,454.31
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$608.63 / $710.58 / $776.03
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$659.29 / $752.88 / $824.92
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,440.00 / $3,475.00 / $6,368.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$628.38 / $858.30 / $1,506.28