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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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$169.42 / $3,016.00 / $10,122.46
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$80.92 / $135.76 / $314.50
Asuris Northwest Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$215.18 / $4,844.06 / $9,885.68
Asuris Northwest Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$131.51 / $260.52 / $3,593.56
Asuris Northwest Health
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$251.46 / $283.47 / $283.47
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$138.58 / $644.92 / $1,110.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$117.33 / $204.91 / $421.84
Kaiser Permanente
Facility/Professional
Facility
Modifier
Low / Median / High Price
$133.19 / $217.92 / $409.69
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$133.50 / $226.52 / $396.81
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$45.17 / $250.50 / $441.36
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$182.25 / $283.41 / $319.58
Premera BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$106.73 / $215.18 / $759.83
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$131.52 / $229.21 / $399.58
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,351.17 / $5,167.93 / $9,885.68
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$126.59 / $219.45 / $369.20
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$629.00 / $1,120.00 / $6,857.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$188.16 / $239.72 / $457.66
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$97.88 / $97.88 / $175.23