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Utah rates for HCPCS 15276

Sub Grft F/S/N/H/F/G/M/D<100sq Cm Ea Addl25sq Cm

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$26.29 / $2,910.00 / $4,387.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20.60 / $28.06 / $49.98
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$29.26 / $38.24 / $51.16
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$24.84 / $32.34 / $44.05
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$27.31 / $37.43 / $53.32
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,078.00 / $1,556.00 / $4,495.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$27.45 / $35.36 / $51.50