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Wyoming 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
Professional
Modifier
Low / Median / High Price
$626.49 / $626.49 / $793.83
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,081.00 / $1,441.00 / $1,824.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$703.54 / $951.54 / $1,384.57
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,275.00 / $1,275.00 / $5,606.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$803.63 / $1,318.80 / $2,379.75