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California rates for HCPCS 15220

Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; 20 sq cm or less

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$771.46 / $5,324.00 / $16,713.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$535.62 / $711.22 / $1,872.79
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,143.00 / $5,931.00 / $11,456.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$532.84 / $729.81 / $1,588.22
Blue Shield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$66.00 / $100.00 / $6,881.37
Blue Shield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$466.55 / $666.50 / $1,528.58
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$587.39 / $824.74 / $1,653.76
Contra Costa Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$294.86 / $832.60 / $1,131.53
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$621.35 / $872.07 / $1,466.97
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,200.78 / $5,564.75 / $16,394.00
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,435.20 / $5,573.28 / $6,506.70
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.34 / $32.34 / $32.34
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$590.99 / $803.09 / $1,160.48
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$596.86 / $867.92 / $1,694.27
Sutter Health Plus
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,999.11 / $1,999.11 / $2,540.08
The Alliance
Facility/Professional
Professional
Modifier
Low / Median / High Price
$383.32 / $632.13 / $1,047.63
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,254.00 / $4,060.00 / $9,476.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$585.32 / $769.30 / $1,742.68