go back

Kansas 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
$412.79 / $3,637.00 / $10,439.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$192.07 / $295.64 / $464.66
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$549.10 / $806.99 / $1,629.79
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$313.76 / $369.13 / $525.90
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$624.00 / $624.00 / $624.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$237.13 / $369.33 / $522.84
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$55.00 / $365.32 / $2,704.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$335.65 / $401.11 / $2,508.56
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$825.00 / $2,081.00 / $3,918.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$327.69 / $375.12 / $538.45