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Oregon 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
$54.69 / $4,684.68 / $8,728.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20.60 / $29.73 / $71.89
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$37.47 / $57.55 / $85.08
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$39.38 / $57.28 / $75.40
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$30.82 / $45.95 / $83.00
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$39.50 / $52.31 / $78.52
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$39.40 / $60.90 / $66.33
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$30.82 / $46.22 / $83.24
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$46.50 / $61.60 / $82.06
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$46.08 / $63.57 / $91.91
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$376.00 / $3,290.00 / $6,216.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$48.02 / $65.66 / $103.20