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Florida 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
$264.64 / $3,279.00 / $10,632.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$191.53 / $264.64 / $383.40
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$323.00 / $977.92 / $1,164.19
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$197.57 / $308.93 / $504.03
Florida Blue
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,144.00 / $5,731.00 / $11,037.00
Florida Blue
Facility/Professional
Professional
Modifier
Low / Median / High Price
$165.52 / $260.45 / $397.81
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$229.17 / $339.96 / $462.87
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,014.00 / $3,611.00 / $8,105.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$234.33 / $311.25 / $561.52
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$170.30 / $260.43 / $260.43