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Washington, DC rates for HCPCS 15101

Split-thickness autograft, trunk, arms, legs; each additional 100 sq cm, 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
$194.45 / $2,986.00 / $6,456.00
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$221.42 / $432.11 / $514.53
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$165.00 / $442.00 / $5,940.00