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Washington, DC rates for HCPCS 15200

Full thickness graft, free, including direct closure of donor site, trunk; 20 sq cm or less

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$867.11 / $2,986.00 / $6,456.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$604.79 / $722.40 / $1,083.49
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$732.47 / $732.47 / $4,930.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$599.45 / $782.75 / $2,222.73
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,010.31 / $1,955.92 / $2,328.98
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
$620.41 / $844.13 / $2,260.23