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Virginia 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
$823.11 / $3,309.00 / $8,294.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$659.66 / $817.31 / $893.08
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,032.00 / $6,548.00 / $7,221.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$682.12 / $863.04 / $1,222.33
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$711.98 / $711.98 / $11,515.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,231.81 / $1,231.81 / $1,231.81
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$685.79 / $855.07 / $1,588.02
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$832.51 / $924.83 / $1,100.99
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$682.41 / $860.37 / $1,185.09
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$890.00 / $1,009.00 / $1,699.01
Sentara
Facility/Professional
Facility
Modifier
Low / Median / High Price
$648.52 / $908.58 / $7,030.19
Sentara
Facility/Professional
Professional
Modifier
Low / Median / High Price
$699.89 / $969.76 / $7,030.19
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,303.00 / $9,270.00 / $17,192.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$554.45 / $832.23 / $1,436.12