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Washington, DC rates for HCPCS 15275

Application of skin substitute graft to face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits, total wound surface area up to 100 sq cm; first 25 sq cm or less wound surface area

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$220.29 / $2,023.50 / $4,100.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$83.60 / $126.69 / $208.40
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$102.97 / $102.97 / $2,116.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$85.85 / $150.15 / $306.45
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$189.43 / $367.70 / $437.83
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$808.00 / $1,171.00 / $26,408.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$113.22 / $158.53 / $424.90