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Connecticut 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
$1,479.11 / $4,897.79 / $8,511.38
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$524.81 / $851.14 / $2,041.74
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,715.35 / $4,168.69 / $10,964.78
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$616.60 / $831.76 / $1,122.02
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$724.44 / $1,047.13 / $1,621.81
ConnectiCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$954.99 / $1,000.00 / $1,000.00
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,388.44 / $6,025.60 / $9,332.54
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$549.54 / $812.83 / $1,412.54