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
$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