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Connecticut rates for HCPCS 15277

Application of skin substitute graft to face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits, total wound surface area greater than or equal to 100 sq cm; first 100 sq cm wound surface area, or 1% of body area of infants and children

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$412.67 / $4,769.00 / $10,492.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$196.13 / $288.20 / $554.20
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8,931.00 / $13,478.00 / $17,938.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$220.41 / $313.67 / $455.12
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$237.80 / $418.14 / $660.44
ConnectiCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$311.97 / $367.02 / $383.40
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,414.00 / $5,950.00 / $9,338.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$251.32 / $418.70 / $734.79