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Utah 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

Facilitymedian $3,467 · 10th–90th $309–$4,8980%20%10th90th$3,467Professionalmedian $309 · 10th–90th $200–$7760%10%10th90th$309$50.0$100.0$200.0$500.0$1.0K$2.0K$5.0K

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$309.03 / $3,467.37 / $4,786.30
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$199.53 / $309.03 / $776.25
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$269.15 / $371.54 / $537.03
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$32.36 / $33.11 / $1,000.00
Regence BlueShield
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$2,630.27 / $3,548.13 / $5,495.41
Regence BlueShield
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$245.47 / $380.19 / $549.54
Select Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$251.19 / $416.87 / $512.86
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$263.03 / $436.52 / $676.08
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$870.96 / $4,466.84 / $5,128.61
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$204.17 / $295.12 / $467.74