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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)

Facilitymedian $3,162 · 10th–90th $34–$4,5710%10%20%10th90th$3,162Professionalmedian $31 · 10th–90th $22–$620%10%10th90th$31$20.0$100.0$500.0$2.0K

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$33.88 / $3,162.28 / $4,570.88
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$21.88 / $30.20 / $75.86
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$30.20 / $39.81 / $52.48
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$32.36 / $33.11 / $83.18
Regence BlueShield
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$27.54 / $39.81 / $56.23
Select Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$28.18 / $40.74 / $58.88
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$27.54 / $41.69 / $57.54
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$660.69 / $4,466.84 / $5,128.61
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$22.91 / $32.36 / $48.98