go back

Washington, DC rates for HCPCS 15277

Application of skin substitute graft to face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits, total wound surface area greater than or equal to 100 sq cm; first 100 sq cm wound surface area, or 1% of body area of infants and children

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$355.85 / $3,575.00 / $4,601.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$210.55 / $284.85 / $385.01
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$225.42 / $225.42 / $2,116.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$205.68 / $322.73 / $748.25
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$405.28 / $786.59 / $936.62
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
$233.14 / $387.59 / $908.97