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Florida 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
$27.82 / $2,919.00 / $10,632.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.34 / $28.54 / $40.31
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$323.00 / $323.00 / $323.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.60 / $31.92 / $51.12
Florida Blue
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,144.00 / $2,674.00 / $6,696.00
Florida Blue
Facility/Professional
Professional
Modifier
Low / Median / High Price
$18.55 / $25.43 / $38.32
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20.77 / $32.34 / $45.54
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$366.00 / $1,950.00 / $4,970.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$25.28 / $33.11 / $58.13
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$18.89 / $25.02 / $25.02