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Washington 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
$42.18 / $90.13 / $14,464.32
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.26 / $31.07 / $65.56
Asuris Northwest Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$43.94 / $55.00 / $249.58
Asuris Northwest Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$35.53 / $62.80 / $2,582.05
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$644.92 / $1,110.00 / $1,110.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.65 / $50.95 / $84.77
Kaiser Permanente
Facility/Professional
Facility
Modifier
Low / Median / High Price
$32.86 / $52.96 / $83.17
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$34.50 / $53.97 / $87.16
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8.97 / $50.60 / $89.76
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$41.04 / $63.54 / $66.33
Premera BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$43.94 / $43.94 / $44.33
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$35.86 / $58.29 / $81.26
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$198.10 / $198.10 / $249.58
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$34.65 / $49.00 / $77.63
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$140.00 / $588.00 / $5,793.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$41.01 / $51.99 / $94.09
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$25.63 / $25.63 / $35.10