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Iowa 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
$112.20 / $3,090.30 / $6,760.83
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$74.13 / $169.82 / $467.74
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$114.82 / $257.04 / $1,621.81
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$165.96 / $302.00 / $380.19
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,148.15 / $1,621.81 / $3,548.13