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Washington rates for HCPCS 15111

Epidermal 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
$141.71 / $293.66 / $14,464.32
Asuris Northwest Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$151.76 / $461.73 / $12,000.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$421.10 / $731.00 / $731.00
Kaiser Permanente
Facility/Professional
Facility
Modifier
Low / Median / High Price
$136.19 / $187.60 / $273.76
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$162.68 / $217.08 / $227.13
Premera BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$151.76 / $151.76 / $154.91
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$908.79 / $908.79 / $1,144.93
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$140.00 / $588.00 / $5,793.00