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Connecticut rates for HCPCS 15276

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; each additional 25 sq cm wound surface area, or part thereof (List separately in addition to code for primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$61.66 / $4,570.88 / $12,882.50
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20.89 / $33.88 / $83.18
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$13,489.63 / $16,595.87 / $22,387.21
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$25.12 / $34.67 / $48.98
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$28.84 / $47.86 / $69.18
ConnectiCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$41.69 / $42.66 / $42.66
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,288.25 / $3,890.45 / $6,760.83
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$23.44 / $38.02 / $61.66