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Michigan 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
$53.37 / $95.98 / $4,933.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$38.27 / $62.71 / $120.93
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$46.01 / $46.01 / $46.01
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$335.64 / $391.51 / $550.83
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.54 / $67.84 / $88.06
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$38.86 / $68.86 / $174.09
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$69.61 / $1,195.68 / $4,933.00
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$53.37 / $69.61 / $120.93
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$54.68 / $67.86 / $95.12
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$464.00 / $1,418.00 / $2,449.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$69.44 / $85.64 / $115.60