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Kansas 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
$981.33 / $4,376.00 / $12,154.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$574.88 / $717.46 / $1,129.05
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$589.00 / $1,123.33 / $1,182.46
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$772.46 / $908.78 / $1,108.26
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$505.00 / $505.00 / $505.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$678.13 / $982.65 / $1,382.88
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$649.61 / $998.02 / $6,026.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$809.47 / $984.48 / $6,214.80
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,436.00 / $3,096.00 / $5,565.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$763.06 / $876.70 / $1,316.14