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Utah 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
$46.49 / $2,910.00 / $4,387.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$36.95 / $67.98 / $234.96
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$51.57 / $74.77 / $126.51
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$47.35 / $61.16 / $75.03
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$48.71 / $80.59 / $110.74
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,078.00 / $1,556.00 / $4,495.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$61.78 / $81.56 / $115.26