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Kansas 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
$46.88 / $3,232.00 / $10,439.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.45 / $27.91 / $44.11
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$35.82 / $42.14 / $55.62
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$624.00 / $624.00 / $624.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$26.76 / $39.59 / $54.32
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$23.72 / $46.84 / $1,087.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$35.17 / $44.39 / $2,582.05
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$191.00 / $550.00 / $1,769.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$33.65 / $39.93 / $55.06