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Idaho 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
$1,628.00 / $4,500.00 / $7,205.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$567.75 / $850.57 / $1,164.84
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$484.21 / $950.78 / $1,240.60
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$560.47 / $920.47 / $1,297.60
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$984.70 / $1,193.58 / $1,502.18
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.34 / $32.34 / $1,206.50
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,306.03 / $4,697.79 / $5,755.74
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$938.09 / $1,136.77 / $1,436.68
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,450.00 / $6,124.00 / $7,609.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$634.60 / $967.12 / $1,322.42