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Illinois 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
$758.58 / $1,949.84 / $5,623.41
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$537.03 / $741.31 / $1,548.82
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,630.27 / $3,235.94 / $11,220.18
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$724.44 / $891.25 / $1,288.25
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$602.56 / $870.96 / $1,412.54
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$645.65 / $1,096.48 / $2,290.87
Hally Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $100.00 / $100.00
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$724.44 / $758.58 / $1,047.13
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $32.36 / $33.11
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,174.90 / $2,290.87 / $4,897.79
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$588.84 / $831.76 / $1,445.44