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Washington, DC rates for HCPCS 15276

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; each additional 25 sq cm wound surface area, or part thereof (List separately in addition to code for primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$32.79 / $1,793.00 / $4,100.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$22.36 / $29.73 / $36.76
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$25.74 / $25.74 / $1,021.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$22.62 / $30.58 / $82.38
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$38.40 / $73.56 / $87.59
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$165.00 / $442.00 / $5,940.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$26.26 / $36.03 / $85.01