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Pennsylvania 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
$704.35 / $2,450.00 / $7,799.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$523.16 / $662.76 / $995.54
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,736.00 / $4,444.00 / $15,949.31
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$758.20 / $786.81 / $1,380.96
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$538.73 / $751.05 / $1,274.91
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$910.94 / $1,171.21 / $1,208.33
Highmark BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,124.68 / $4,466.38 / $9,784.50
Highmark BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$739.24 / $767.39 / $1,051.02
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$875.62 / $2,679.00 / $8,017.00
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$529.11 / $711.22 / $1,539.00
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$762.00 / $762.00 / $804.10
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,024.71 / $1,024.71 / $1,024.71
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$563.44 / $770.12 / $1,357.94
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$590.86 / $612.75 / $754.68
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$590.53 / $729.83 / $796.92
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$814.00 / $2,113.00 / $4,789.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$658.43 / $838.85 / $1,494.48