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Washington 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
$786.03 / $1,802.67 / $14,464.32
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$532.95 / $786.03 / $1,613.08
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,236.02 / $1,236.02 / $1,236.02
Asuris Northwest Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,060.70 / $5,167.93 / $11,429.12
Asuris Northwest Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$860.95 / $1,606.13 / $5,728.24
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$564.00 / $906.00 / $2,323.83
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$764.22 / $1,186.14 / $2,071.75
Kaiser Permanente
Facility/Professional
Facility
Modifier
Low / Median / High Price
$800.44 / $1,279.61 / $1,986.82
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$855.00 / $1,332.05 / $2,125.62
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$75.04 / $453.68 / $1,555.44
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,007.19 / $1,428.04 / $1,555.07
Premera BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$759.83 / $1,040.51 / $1,060.70
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$861.98 / $1,428.89 / $1,944.30
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,351.17 / $5,167.93 / $9,885.68
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$823.75 / $1,192.98 / $1,869.39
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$629.00 / $1,612.00 / $6,857.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$923.16 / $1,176.15 / $2,223.54
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$668.12 / $668.12 / $856.35