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Utah 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

Facilitymedian $3,715 · 10th–90th $676–$6,0260%10%10th90th$3,715Professionalmedian $741 · 10th–90th $617–$1,5140%10%20%10th90th$741$50.0$200.0$1.0K$5.0K

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$676.08 / $3,388.44 / $4,897.79
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$616.60 / $724.44 / $1,659.59
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$776.25 / $933.25 / $1,258.93
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$32.36 / $33.11 / $1,148.15
Regence BlueShield
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$5,248.07 / $7,244.36 / $10,964.78
Regence BlueShield
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$812.83 / $1,023.29 / $1,513.56
Select Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$776.25 / $1,023.29 / $1,380.38
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$794.33 / $1,047.13 / $1,479.11
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,202.26 / $5,128.61 / $8,317.64
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$588.84 / $776.25 / $1,148.15