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Maryland 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
$0.98 / $0.98 / $0.98
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.10 / $29.26 / $64.80
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$25.74 / $25.74 / $32.69
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$23.00 / $32.32 / $57.61
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$33.65 / $41.68 / $73.17
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$150.00 / $150.00 / $150.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$28.30 / $34.61 / $64.48
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$26.30 / $28.62 / $38.72