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Utah rates for HCPCS 15220

Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; 20 sq cm or less

Facilitymedian $3,162 · 10th–90th $794–$4,8980%10%20%10th90th$3,162Professionalmedian $759 · 10th–90th $537–$1,6600%10%10th90th$759$50.0$100.0$200.0$500.0$1.0K$2.0K$5.0K

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$794.33 / $3,162.28 / $4,786.30
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$524.81 / $758.58 / $1,698.24
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$691.83 / $891.25 / $1,202.26
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$32.36 / $33.11 / $3,090.30
Regence BlueShield
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$2,630.27 / $3,548.13 / $5,495.41
Regence BlueShield
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$676.08 / $954.99 / $1,698.24
Select Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$691.83 / $954.99 / $1,412.54
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$575.44 / $933.25 / $1,862.09
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$870.96 / $4,466.84 / $5,128.61
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$537.03 / $707.95 / $1,096.48