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Idaho 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
$172.31 / $2,143.56 / $4,963.21
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$86.90 / $144.31 / $245.45
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$100.03 / $170.64 / $260.08
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$97.99 / $150.40 / $257.72
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$149.44 / $181.14 / $307.94
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.34 / $32.34 / $249.64
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,306.03 / $4,697.79 / $5,755.74
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$141.69 / $189.72 / $298.23
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,450.00 / $6,124.00 / $7,609.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$159.25 / $201.60 / $268.80