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Utah 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
$160.50 / $2,910.00 / $4,387.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$141.06 / $160.50 / $265.47
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$173.21 / $212.64 / $267.17
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$141.28 / $166.01 / $215.13
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$179.70 / $215.95 / $274.91
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,078.00 / $1,556.00 / $4,495.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$149.96 / $186.85 / $267.85