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Idaho 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
$1,628.00 / $4,500.00 / $7,205.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$219.88 / $340.89 / $529.17
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$226.30 / $382.75 / $558.17
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$228.08 / $354.35 / $555.64
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$355.99 / $431.50 / $659.86
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.34 / $32.34 / $527.14
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,306.03 / $4,697.79 / $5,755.74
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$338.10 / $444.34 / $641.11
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,450.00 / $6,124.00 / $7,609.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$306.60 / $420.48 / $567.82