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Virginia 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
$796.20 / $3,116.00 / $8,294.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$563.84 / $711.22 / $1,349.98
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,060.00 / $3,693.00 / $4,290.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$582.01 / $792.61 / $1,140.27
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$676.17 / $676.17 / $3,774.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,024.71 / $1,024.71 / $1,024.71
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$596.50 / $809.14 / $1,447.05
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$808.79 / $902.02 / $1,073.83
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$578.88 / $796.20 / $1,142.50
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$932.00 / $1,089.00 / $1,582.70
Sentara
Facility/Professional
Facility
Modifier
Low / Median / High Price
$611.59 / $791.86 / $3,123.00
Sentara
Facility/Professional
Professional
Modifier
Low / Median / High Price
$700.60 / $950.28 / $3,326.94
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,629.00 / $2,819.00 / $5,764.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$583.46 / $816.62 / $1,400.13