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Washington, DC rates for HCPCS 15115

Epidermal autograft, face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits; first 100 sq cm or less, or 1% of body area of infants and children

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$816.20 / $2,080.00 / $4,601.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$612.64 / $695.89 / $816.20
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$796.14 / $796.14 / $1,845.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$658.46 / $777.82 / $2,100.60
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$965.57 / $1,855.67 / $2,209.61
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$808.00 / $2,680.00 / $26,408.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$607.72 / $886.87 / $2,144.38