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Connecticut 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
$144.54 / $4,677.35 / $8,511.38
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,801.89 / $5,888.44 / $8,128.31
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,288.25 / $3,890.45 / $6,760.83