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California rates for HCPCS 15157

Tissue cultured skin autograft, face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits; 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
$1,659.59 / $6,025.60 / $16,982.44
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$134.90 / $169.82 / $891.25
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,630.78 / $6,165.95 / $13,489.63
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$147.91 / $213.80 / $478.63
Blue Shield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$64.57 / $100.00 / $5,888.44
Blue Shield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$165.96 / $223.87 / $478.63
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$158.49 / $199.53 / $371.54
Contra Costa Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$151.36 / $190.55 / $251.19
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$138.04 / $194.98 / $346.74
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,000.00 / $19,498.45 / $19,498.45
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,513.56 / $1,513.56 / $1,513.56
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$154.88 / $154.88 / $257.04
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$141.25 / $194.98 / $295.12
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$154.88 / $204.17 / $380.19
Sutter Health Plus
Facility/Professional
Professional
Modifier
Low / Median / High Price
$524.81 / $524.81 / $562.34
The Alliance
Facility/Professional
Professional
Modifier
Low / Median / High Price
$138.04 / $204.17 / $295.12
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$588.84 / $1,584.89 / $6,760.83
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$131.83 / $177.83 / $346.74