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Washington, DC rates for HCPCS 15120

Split-thickness 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 (except 15050)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$870.96 / $2,238.72 / $4,570.88
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$616.60 / $776.25 / $1,949.84
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$645.65 / $1,659.59 / $6,456.54
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$660.69 / $851.14 / $1,778.28
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$933.25 / $1,737.80 / $2,344.23
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,311.31 / $14,791.08 / $26,915.35
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$645.65 / $812.83 / $1,819.70