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Idaho 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
$1,407.00 / $4,500.00 / $7,045.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.79 / $34.35 / $49.98
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.04 / $41.16 / $53.48
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$23.37 / $38.96 / $53.99
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$39.50 / $52.31 / $63.40
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.34 / $32.34 / $51.45
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$37.85 / $46.88 / $60.98
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,800.00 / $8,244.00 / $9,193.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$34.65 / $43.12 / $57.82