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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 / $912.01 / $2,398.83
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$478.63 / $758.58 / $1,862.09
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$575.44 / $645.65 / $741.31
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$562.34 / $741.31 / $1,348.96
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$758.58 / $933.25 / $1,584.89
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$446.68 / $446.68 / $707.95
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$537.03 / $741.31 / $1,380.38
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$602.56 / $831.76 / $1,288.25