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Idaho rates for HCPCS 15273

Application of skin substitute graft to trunk, arms, legs, total wound surface area greater than or equal to 100 sq cm; first 100 sq cm wound surface area, or 1% of body area of infants and children

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,628.00 / $4,500.00 / $7,205.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$179.87 / $294.20 / $481.70
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$206.32 / $349.39 / $509.52
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$201.27 / $313.87 / $505.79
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$309.02 / $486.75 / $590.00
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.34 / $32.34 / $471.05
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,960.99 / $8,854.77 / $10,870.07
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$296.67 / $402.28 / $577.05
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$9,360.00 / $16,762.00 / $17,870.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$287.43 / $392.92 / $526.87