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Idaho 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
$1,621.81 / $4,466.84 / $5,495.41
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$223.87 / $1,230.27 / $2,511.89
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$69.18 / $138.04 / $281.84
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,819.70 / $8,317.64 / $9,332.54