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Kansas 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
$79.43 / $2,691.53 / $7,585.78
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$38.90 / $69.18 / $138.04
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $32.36 / $32.36
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$74.13 / $74.13 / $120.23
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$630.96 / $630.96 / $630.96
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$47.86 / $75.86 / $125.89
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$46.77 / $95.50 / $1,288.25
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$75.86 / $93.33 / $3,388.44
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$190.55 / $537.03 / $1,905.46
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$47.86 / $75.86 / $109.65