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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
$2,398.83 / $3,235.94 / $3,981.07
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$630.96 / $812.83 / $1,905.46
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$524.81 / $707.95 / $1,174.90
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$707.95 / $1,047.13 / $1,778.28
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,570.40 / $4,570.88 / $7,585.78
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$562.34 / $933.25 / $1,584.89