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Idaho 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
$1,407.00 / $4,500.00 / $7,045.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$38.78 / $67.98 / $126.57
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$55.27 / $80.13 / $129.04
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$45.47 / $71.51 / $132.90
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$69.91 / $85.14 / $153.96
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.34 / $32.34 / $122.45
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$67.52 / $91.40 / $152.37
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,800.00 / $8,244.00 / $9,193.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$71.75 / $99.44 / $131.19