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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
$1,598.33 / $2,778.87 / $3,955.04
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$165.72 / $244.02 / $323.81
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$194.56 / $311.39 / $492.09
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$236.67 / $376.22 / $703.28
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,812.00 / $4,049.00 / $5,510.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$282.66 / $433.81 / $752.74