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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
$95.76 / $3,232.00 / $10,439.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$38.40 / $70.68 / $110.57
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$63.86 / $75.13 / $120.23
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$624.00 / $624.00 / $624.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$48.86 / $76.36 / $124.36
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$43.39 / $84.77 / $1,087.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$76.98 / $93.40 / $3,377.81
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$191.00 / $550.00 / $1,769.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$73.73 / $88.04 / $124.30