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Pennsylvania 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
$90.20 / $2,240.00 / $7,629.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$48.06 / $72.87 / $107.25
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,299.82 / $2,746.00 / $13,822.74
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$92.12 / $151.55 / $159.97
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$53.96 / $86.91 / $144.13
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$111.74 / $143.66 / $148.83
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$617.00 / $2,371.00 / $8,017.00
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$49.30 / $84.47 / $570.05
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$94.94 / $94.94 / $94.94
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$55.04 / $87.50 / $148.51
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$50.15 / $54.26 / $92.52
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$52.20 / $73.27 / $98.96
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$144.00 / $674.00 / $4,300.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.63 / $100.16 / $173.67