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Washington, DC rates for HCPCS 15278

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; each additional 100 sq cm wound surface area, or part thereof, or each additional 1% of body area of infants and children, or part thereof (List separately in addition to code for primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$98.92 / $1,793.00 / $4,100.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$52.57 / $75.14 / $98.92
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$57.26 / $57.26 / $1,021.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$51.48 / $86.78 / $185.56
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$112.54 / $219.59 / $261.48
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
$69.36 / $94.15 / $253.76