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Iowa 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
$1,128.70 / $3,666.78 / $7,119.04
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$203.66 / $333.44 / $1,260.16
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$329.77 / $605.75 / $958.29
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$205.96 / $396.25 / $868.72
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$333.44 / $605.29 / $5,023.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$386.02 / $596.90 / $1,622.24
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$514.49 / $821.21 / $1,913.58
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$445.96 / $605.29 / $931.67
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,044.00 / $5,023.00 / $7,305.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$353.85 / $500.46 / $1,047.16
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$395.40 / $465.20 / $711.40