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Pennsylvania 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
$29.92 / $2,240.00 / $7,629.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.26 / $28.54 / $40.10
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,083.51 / $1,395.00 / $12,759.45
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.39 / $54.63 / $66.38
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$22.95 / $33.15 / $57.77
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$38.09 / $48.98 / $50.42
Highmark BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,564.67 / $2,564.67 / $2,564.67
Highmark BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$54.48 / $54.48 / $54.48
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$594.00 / $2,371.00 / $8,017.00
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.91 / $30.36 / $134.11
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$37.29 / $37.29 / $42.40
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$42.41 / $42.41 / $42.41
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$24.04 / $33.61 / $60.52
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$22.88 / $24.47 / $31.74
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$23.60 / $30.39 / $33.47
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$144.00 / $674.00 / $4,300.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.06 / $38.51 / $66.54