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Utah 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
$159.49 / $3,284.87 / $7,760.60
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$82.34 / $131.59 / $500.99
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$110.56 / $154.77 / $249.31
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$117.29 / $151.15 / $183.27
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,814.80 / $3,509.81 / $5,038.84
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$102.21 / $174.85 / $231.06
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,689.00 / $2,312.00 / $4,640.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$128.72 / $161.28 / $236.69