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Pennsylvania 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
$147.91 / $2,951.21 / $7,413.10
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$81.28 / $138.04 / $446.68
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$41.69 / $81.28 / $147.91
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,344.23 / $2,570.40 / $57,543.99
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$154.88 / $257.04 / $302.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$91.20 / $151.36 / $223.87
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$190.55 / $245.47 / $269.15
Geisinger
Facility/Professional
Professional
Modifier
Low / Median / High Price
$138.04 / $208.93 / $281.84
Highmark BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,412.54 / $3,890.45 / $6,606.93
Highmark BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$144.54 / $154.88 / $158.49
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$199.53 / $2,570.40 / $7,244.36
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$83.18 / $147.91 / $363.08
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$173.78 / $173.78 / $173.78
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$28.18 / $93.33 / $302.00
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$48.98 / $151.36 / $302.00
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$912.01 / $2,238.72 / $4,265.80
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$87.10 / $147.91 / $245.47