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Utah 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
$220.08 / $3,038.00 / $4,626.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$171.28 / $264.39 / $496.84
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$227.83 / $307.74 / $483.75
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$235.61 / $289.73 / $351.08
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,537.58 / $6,904.89 / $9,912.95
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$214.02 / $341.69 / $463.33
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,155.00 / $6,097.00 / $8,267.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$241.71 / $317.49 / $521.12