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Washington, DC rates for HCPCS 15136

Dermal autograft, face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits; 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
$96.61 / $1,793.00 / $4,100.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$71.41 / $89.37 / $96.61
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$85.91 / $85.91 / $1,021.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$81.56 / $90.67 / $247.88
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$113.86 / $217.34 / $258.79
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$165.00 / $442.00 / $5,940.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$72.54 / $98.55 / $251.15