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Wyoming 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
Professional
Modifier
Low / Median / High Price
$689.37 / $689.37 / $863.03
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,194.00 / $1,591.00 / $1,990.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$770.46 / $1,034.84 / $1,494.78
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,607.00 / $2,607.00 / $10,877.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$843.20 / $1,435.79 / $2,590.86