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Rhode Island 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
$1,518.41 / $1,543.03 / $3,955.04
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$33.31 / $53.69 / $73.64
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$38.09 / $70.18 / $114.29
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$47.77 / $87.67 / $162.57
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$540.00 / $1,401.00 / $4,915.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$69.33 / $98.89 / $174.15