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Washington 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

Facilitymedian $1,820 · 10th–90th $1,072–$10,7150%5%10%10th90th$1,820Professionalmedian $1,047 · 10th–90th $617–$1,9950%5%10%10th90th$1,047$50.0$200.0$1.0K$5.0K$20.0K

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,318.26 / $2,089.30 / $17,782.79
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$602.56 / $870.96 / $1,819.70
Asuris Northwest Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$3,548.13 / $4,897.79 / $10,000.00
Asuris Northwest Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$933.25 / $1,318.26 / $2,041.74
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$562.34 / $912.01 / $2,344.23
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$831.76 / $1,318.26 / $2,238.72
Kaiser Permanente
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,000.00 / $1,513.56 / $2,511.89
Kaiser Permanente
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,023.29 / $1,513.56 / $2,137.96
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$32.36 / $33.11 / $316.23
Pacific Source
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,071.52 / $1,548.82 / $1,659.59
Premera BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,071.52 / $1,071.52 / $1,122.02
Premera BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$954.99 / $1,288.25 / $2,041.74
Regence BlueShield
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$3,388.44 / $5,011.87 / $10,000.00
Regence BlueShield
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$933.25 / $1,318.26 / $1,905.46
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,621.81 / $6,456.54 / $11,748.98
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$870.96 / $1,071.52 / $1,995.26
Wellpoint
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$707.95 / $977.24 / $1,348.96