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Pennsylvania 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
$294.12 / $2,675.00 / $8,017.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$171.92 / $263.32 / $398.12
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,299.82 / $2,746.00 / $13,822.74
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$298.58 / $494.71 / $579.71
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$181.84 / $295.77 / $503.63
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$359.65 / $462.40 / $478.25
Highmark BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7,045.31 / $8,625.20 / $9,959.09
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$692.40 / $2,675.00 / $8,017.00
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$173.87 / $286.95 / $873.53
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$331.70 / $331.70 / $331.70
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$329.19 / $329.19 / $329.19
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$190.93 / $298.02 / $544.45
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$190.73 / $191.51 / $302.02
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$190.73 / $265.49 / $322.35
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,155.00 / $3,475.00 / $6,368.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$275.01 / $345.32 / $599.75