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Connecticut rates for HCPCS 15200

Full thickness graft, free, including direct closure of donor site, trunk; 20 sq cm or less

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,621.81 / $5,495.41 / $9,549.93
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$562.34 / $912.01 / $2,187.76
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,715.35 / $4,168.69 / $12,022.64
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$676.08 / $912.01 / $1,230.27
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$724.44 / $1,148.15 / $1,778.28
ConnectiCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,000.00 / $1,047.13 / $1,047.13
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,570.88 / $7,079.46 / $11,220.18
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$602.56 / $891.25 / $1,548.82