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Rhode Island 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
$1,518.41 / $1,543.03 / $3,955.04
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20.60 / $25.72 / $32.71
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.66 / $33.96 / $45.75
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$26.73 / $35.81 / $66.26
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$540.00 / $1,401.00 / $4,915.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.06 / $47.84 / $74.97