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California rates for HCPCS 15275

Application of skin substitute graft to face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits, total wound surface area up to 100 sq cm; first 25 sq cm or less wound surface area

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$179.99 / $4,941.00 / $15,795.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$80.92 / $134.77 / $466.00
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,894.00 / $4,734.00 / $9,589.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$86.20 / $143.41 / $294.55
Anthem BCBS
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$152.40 / $224.40 / $246.57
Blue Shield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$66.00 / $100.00 / $6,881.37
Blue Shield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$100.00 / $154.59 / $304.83
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$100.24 / $164.56 / $302.92
Contra Costa Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$83.02 / $123.90 / $231.86
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$93.15 / $163.56 / $297.06
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$55.00 / $639.72 / $650.76
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,179.06 / $3,306.22 / $3,737.30
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.34 / $32.34 / $32.34
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$90.95 / $142.86 / $234.25
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$100.95 / $172.88 / $303.36
Sutter Health Plus
Facility/Professional
Professional
Modifier
Low / Median / High Price
$310.85 / $310.85 / $518.82
The Alliance
Facility/Professional
Professional
Modifier
Low / Median / High Price
$83.38 / $136.11 / $214.73
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,230.00 / $4,243.00 / $9,131.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$120.96 / $163.99 / $393.86