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Washington, DC rates for HCPCS 15201

Full thickness graft, free, including direct closure of donor site, trunk; each additional 20 sq cm, or part thereof (List separately in addition to code for primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$75.86 / $4,073.80 / $4,570.88
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$158.49 / $204.17 / $389.05
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$165.96 / $549.54 / $5,888.44