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Georgia 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
$299.32 / $3,460.00 / $6,915.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$192.21 / $299.32 / $492.45
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$996.37 / $2,722.51 / $5,292.58
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$240.25 / $372.29 / $612.82
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$202.96 / $319.73 / $651.63
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$240.35 / $365.57 / $1,583.00
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$317.94 / $424.78 / $586.92
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,036.00 / $3,250.00 / $5,272.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$317.99 / $458.00 / $858.30