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Delaware 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
$3,949.00 / $3,949.00 / $6,907.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$528.87 / $662.76 / $675.57
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$525.41 / $694.77 / $987.67
Highmark BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7,150.78 / $7,150.78 / $7,150.78
Highmark BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$554.41 / $554.41 / $554.41
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $100.00 / $100.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$555.28 / $805.61 / $1,772.34