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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
$2,089.30 / $2,754.23 / $3,981.07
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$537.03 / $758.58 / $1,862.09
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$478.63 / $645.65 / $1,071.52
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$645.65 / $954.99 / $1,621.81
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,819.70 / $4,073.80 / $6,165.95
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$537.03 / $870.96 / $1,445.44