go back

Utah rates for HCPCS 15271

Application of skin substitute graft to trunk, arms, legs, total wound surface area up to 100 sq cm; first 25 sq cm or less wound surface area

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$147.91 / $3,388.44 / $7,413.10
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$72.44 / $125.89 / $234.42
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$100.00 / $131.83 / $239.88
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $33.11 / $354.81
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,818.38 / $3,311.31 / $7,244.36
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$91.20 / $154.88 / $239.88
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$95.50 / $158.49 / $263.03
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$102.33 / $194.98 / $269.15
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,698.24 / $4,466.84 / $5,128.61
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$75.86 / $125.89 / $204.17