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Minnesota 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
$588.70 / $755.87 / $2,525.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$563.84 / $708.87 / $1,161.38
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,370.01 / $3,863.89 / $7,374.76
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$994.63 / $1,537.34 / $2,641.09
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,914.47 / $2,714.95 / $6,531.18
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,220.38 / $2,040.64 / $3,276.01
Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,556.32 / $2,482.12 / $5,142.66
Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,151.47 / $1,831.29 / $3,079.19
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$669.85 / $1,141.33 / $2,313.41
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$872.58 / $1,533.32 / $4,532.56
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,580.95 / $2,523.00 / $6,275.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$872.58 / $1,451.79 / $2,895.36