go back

Maryland 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
$0.98 / $1,293.76 / $2,401.02
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$532.95 / $713.03 / $1,626.06
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$608.54 / $676.17 / $777.60
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$579.77 / $757.89 / $1,310.85
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$798.48 / $1,011.06 / $1,766.75
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$450.00 / $450.00 / $450.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$589.75 / $771.15 / $1,450.78
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$615.41 / $675.16 / $923.55