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California rates for HCPCS 15201

Full thickness graft, free, including direct closure of donor site, trunk; each additional 20 sq cm, or part thereof (List separately in addition to code for primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,290.87 / $6,456.54 / $16,982.44
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,630.78 / $6,165.95 / $13,489.63
Blue Shield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$64.57 / $100.00 / $7,943.28
Contra Costa Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$70.79 / $85.11 / $213.80
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$63.10 / $147.91 / $288.40
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,995.26 / $28,840.32 / $28,840.32
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$66.07 / $125.89 / $229.09
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$588.84 / $1,584.89 / $6,760.83