go back

Utah 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
$33.88 / $3,162.28 / $4,570.88
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20.89 / $29.51 / $54.95
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$28.18 / $38.02 / $51.29
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $33.11 / $83.18
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$27.54 / $39.81 / $56.23
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$28.18 / $37.15 / $58.88
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.20 / $41.69 / $60.26
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,071.52 / $4,466.84 / $5,128.61
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$22.39 / $31.62 / $48.98