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Idaho rates for HCPCS 15278

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; each additional 100 sq cm wound surface area, or part thereof, or each additional 1% of body area of infants and children, or part thereof (List separately in addition to code for primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,407.00 / $4,500.00 / $7,045.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$56.37 / $85.39 / $146.97
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$63.42 / $100.33 / $152.82
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$57.65 / $89.66 / $154.33
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$89.13 / $108.04 / $182.44
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.34 / $32.34 / $144.83
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$84.40 / $114.94 / $176.83
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,800.00 / $8,244.00 / $9,193.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$84.35 / $117.48 / $154.86