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Florida 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
$58.75 / $3,241.00 / $10,802.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$38.57 / $58.75 / $90.83
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$323.00 / $323.00 / $323.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$40.02 / $68.27 / $112.28
Florida Blue
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,144.00 / $2,674.00 / $6,696.00
Florida Blue
Facility/Professional
Professional
Modifier
Low / Median / High Price
$38.24 / $60.66 / $92.39
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$43.92 / $65.78 / $94.02
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$366.00 / $1,950.00 / $4,970.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$53.71 / $73.19 / $126.54
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$33.45 / $60.77 / $60.77