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Georgia 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
$71.40 / $2,572.00 / $6,915.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$38.40 / $68.28 / $128.06
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7,875.00 / $7,875.00 / $7,875.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$49.25 / $79.94 / $139.44
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$43.59 / $73.59 / $152.34
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$47.30 / $85.26 / $144.00
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$63.64 / $99.99 / $139.52
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$353.00 / $1,580.00 / $2,665.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$65.25 / $103.87 / $177.52