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Utah 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
$57.65 / $2,910.00 / $4,387.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$44.65 / $80.91 / $211.48
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$65.68 / $87.56 / $148.10
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$70.11 / $90.31 / $110.94
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.89 / $98.97 / $132.81
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,078.00 / $1,556.00 / $4,495.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$72.27 / $96.12 / $137.79