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Kentucky 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
$89.92 / $148.76 / $5,215.53
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$81.17 / $130.31 / $178.85
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,359.00 / $2,292.00 / $4,516.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$81.09 / $120.38 / $158.87
Anthem BCBS
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$121.63 / $180.57 / $238.30
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$86.92 / $117.34 / $133.47
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$108.65 / $156.77 / $228.03
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$159.93 / $159.93 / $1,111.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$89.16 / $146.97 / $300.42
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.34 / $32.34 / $185.28
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$523.00 / $1,450.00 / $4,039.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$134.19 / $181.05 / $262.73