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Rhode Island 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
$2,424.15 / $3,243.94 / $3,955.04
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$505.71 / $665.27 / $859.62
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$598.94 / $879.31 / $1,180.40
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$709.97 / $951.56 / $1,721.09
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,569.00 / $4,571.00 / $7,350.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$588.41 / $931.23 / $1,788.11