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Washington rates for HCPCS 15274

Application of skin substitute graft to trunk, arms, legs, total wound surface area greater than or equal to 100 sq cm; each additional 100 sq cm wound surface area, or part thereof, or each additional 1% of body area of infants and children, or part thereof (List separately in addition to code for primary procedure)

Facilitymedian $155 · 10th–90th $81–$9,7720%5%10%10th90th$155Professionalmedian $79 · 10th–90th $40–$2000%5%10%10th90th$79$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
$89.13 / $2,290.87 / $17,782.79
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$38.02 / $67.61 / $213.80
Asuris Northwest Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$724.44 / $724.44 / $724.44
Asuris Northwest Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$61.66 / $104.71 / $190.55
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$645.65 / $645.65 / $1,122.02
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$56.23 / $104.71 / $229.09
Kaiser Permanente
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$64.57 / $107.15 / $194.98
Kaiser Permanente
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$67.61 / $107.15 / $194.98
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$32.36 / $33.11 / $56.23
Pacific Source
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$93.33 / $144.54 / $154.88
Premera BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$112.20 / $114.82 / $114.82
Premera BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$60.26 / $112.20 / $194.98
Regence BlueShield
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$575.44 / $575.44 / $724.44
Regence BlueShield
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$61.66 / $104.71 / $169.82
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$141.25 / $645.65 / $5,754.40
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$57.54 / $97.72 / $177.83
Wellpoint
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$40.74 / $77.62 / $125.89