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Washington 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

Facilitymedian $427 · 10th–90th $162–$9,5500%10%10th90th$427Professionalmedian $162 · 10th–90th $81–$4680%10%10th90th$162$1.0$10.0$100.0$1.0K$10.0K

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
$173.78 / $3,467.37 / $10,232.93
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$81.28 / $141.25 / $489.78
Ambetter
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$77.62 / $77.62 / $77.62
Asuris Northwest Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$3,548.13 / $4,897.79 / $10,000.00
Asuris Northwest Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$125.89 / $218.78 / $380.19
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$138.04 / $208.93 / $1,122.02
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$123.03 / $213.80 / $446.68
Kaiser Permanente
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$138.04 / $229.09 / $426.58
Kaiser Permanente
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$138.04 / $229.09 / $380.19
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$32.36 / $33.11 / $58.88
Pacific Source
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$223.87 / $309.03 / $316.23
Premera BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$213.80 / $213.80 / $218.78
Premera BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$125.89 / $218.78 / $398.11
Regence BlueShield
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$3,388.44 / $5,011.87 / $10,000.00
Regence BlueShield
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$125.89 / $213.80 / $338.84
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$676.08 / $2,570.40 / $5,011.87
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$123.03 / $194.98 / $346.74
Wellpoint
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$97.72 / $169.82 / $234.42