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Michigan 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
$708.87 / $1,121.42 / $4,933.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$532.95 / $708.87 / $995.54
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,852.42 / $2,159.06 / $2,925.19
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$156.19 / $775.22 / $1,021.96
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$527.40 / $731.33 / $2,572.46
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$781.85 / $1,346.50 / $4,933.00
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$658.42 / $781.85 / $1,164.84
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$68.25 / $549.17 / $863.55
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,050.00 / $3,523.00 / $6,327.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$713.93 / $870.60 / $1,177.47