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Rhode Island 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
$1,584.89 / $1,584.89 / $3,981.07
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$186.21 / $288.40 / $562.34
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$169.82 / $263.03 / $416.87
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$239.88 / $389.05 / $724.44
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,819.70 / $4,073.80 / $6,165.95
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$208.93 / $354.81 / $616.60