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Rhode Island 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
$2,090.73 / $2,778.87 / $3,955.04
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$465.67 / $624.53 / $810.04
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$565.69 / $808.13 / $1,081.57
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$640.97 / $876.87 / $1,582.41
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,806.00 / $3,465.00 / $5,510.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$583.25 / $986.95 / $1,641.50