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California rates for HCPCS 15274

Application of skin substitute graft to trunk, arms, legs, total wound surface area greater than or equal to 100 sq cm; each additional 100 sq cm wound surface area, or part thereof, 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
$1,659.59 / $6,025.60 / $16,595.87
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$38.02 / $67.61 / $446.68
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,570.40 / $4,466.84 / $12,882.50
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$39.81 / $70.79 / $162.18
Blue Shield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$64.57 / $275.42 / $2,089.30
Blue Shield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$45.71 / $79.43 / $162.18
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$45.71 / $75.86 / $141.25
Contra Costa Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$36.31 / $50.12 / $125.89
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$38.02 / $87.10 / $165.96
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$54.95 / $56.23 / $275.42
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,548.13 / $3,548.13 / $3,548.13
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$69.18 / $69.18 / $114.82
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$38.90 / $66.07 / $131.83
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$45.71 / $75.86 / $141.25
Sutter Health Plus
Facility/Professional
Professional
Modifier
Low / Median / High Price
$144.54 / $144.54 / $257.04
The Alliance
Facility/Professional
Professional
Modifier
Low / Median / High Price
$36.31 / $60.26 / $93.33
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$588.84 / $1,584.89 / $6,760.83
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$38.90 / $66.07 / $131.83