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Iowa 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
$2,218.00 / $3,576.15 / $7,119.04
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$23.38 / $37.64 / $134.63
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$36.96 / $68.17 / $92.52
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$23.05 / $41.24 / $116.23
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$36.54 / $60.55 / $1,607.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$38.83 / $65.52 / $2,210.02
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$53.87 / $71.33 / $99.64
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$51.18 / $68.95 / $87.67
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,204.00 / $1,623.00 / $2,126.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$35.60 / $51.61 / $92.34
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$43.90 / $51.60 / $68.40