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Washington rates for HCPCS 15155

Tissue cultured skin autograft, face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits; first 25 sq cm or less

Facilitymedian $1,820 · 10th–90th $1,047$13,8040%10%10th90th$1,820Professionalmedian $1,047 · 10th–90th $575$1,9950%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
$1,380.38 / $2,041.74 / $17,782.79
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$537.03 / $870.96 / $1,819.70
Asuris Northwest Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$6,760.83 / $9,549.93 / $19,498.45
Asuris Northwest Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$933.25 / $1,380.38 / $2,041.74
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$562.34 / $912.01 / $4,677.35
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$870.96 / $1,318.26 / $2,238.72
Kaiser Permanente
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$977.24 / $1,621.81 / $4,265.80
Kaiser Permanente
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,000.00 / $1,584.89 / $2,398.83
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$32.36 / $33.11 / $331.13
Pacific Source
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,000.00 / $1,479.11 / $1,584.89
Premera BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,071.52 / $1,096.48 / $1,318.26
Premera BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,000.00 / $1,348.96 / $2,089.30
Regence BlueShield
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$6,760.83 / $10,000.00 / $19,498.45
Regence BlueShield
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$933.25 / $1,380.38 / $1,905.46
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$2,951.21 / $11,220.18 / $20,417.38
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$851.14 / $1,023.29 / $2,041.74
Wellpoint
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$724.44 / $954.99 / $1,380.38