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Michigan 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
$109.76 / $231.19 / $4,271.34
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$85.79 / $135.96 / $231.19
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,146.73 / $2,502.09 / $3,389.93
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$22.51 / $139.44 / $188.24
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$88.49 / $97.34 / $131.44
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$151.22 / $161.77 / $240.84
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$81.52 / $137.59 / $387.02
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$111.74 / $982.21 / $4,444.31
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$102.93 / $156.72 / $240.33
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$137.22 / $168.68 / $236.61
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,527.00 / $3,640.00 / $6,740.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$145.51 / $177.85 / $248.52