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Wyoming 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
$4,086.02 / $4,086.02 / $4,086.02
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$92.07 / $94.13 / $162.88
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$163.00 / $262.00 / $375.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$110.58 / $175.92 / $267.89
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,275.00 / $1,275.00 / $5,606.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$188.16 / $268.80 / $500.49