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Washington, DC rates for HCPCS 15130

Dermal autograft, trunk, arms, legs; 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
$749.71 / $3,575.00 / $4,601.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$497.43 / $611.04 / $749.71
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$618.63 / $618.63 / $3,307.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$536.01 / $659.61 / $1,930.45
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$866.54 / $1,675.94 / $1,995.60
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,832.00 / $2,343.00 / $26,408.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$525.04 / $725.81 / $1,936.69