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Wyoming 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
Professional
Modifier
Low / Median / High Price
$43.55 / $45.38 / $81.09
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$78.00 / $125.00 / $191.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$53.29 / $84.79 / $128.59
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$293.00 / $293.00 / $3,239.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$90.20 / $135.60 / $244.68