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Utah rates for HCPCS 15200

Full thickness graft, free, including direct closure of donor site, trunk; 20 sq cm or less

Facilitymedian $4,467 · 10th–90th $851–$7,9430%10%10th90th$4,467Professionalmedian $813 · 10th–90th $617–$2,5700%10%20%10th90th$813$50.0$200.0$1.0K$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
$851.14 / $4,570.88 / $7,943.28
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$616.60 / $776.25 / $2,570.40
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$741.31 / $977.24 / $1,318.26
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$32.36 / $33.11 / $3,548.13
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
$741.31 / $1,047.13 / $1,819.70
Select Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$758.58 / $1,047.13 / $1,548.82
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$645.65 / $1,023.29 / $2,089.30
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$870.96 / $4,466.84 / $7,079.46
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$575.44 / $776.25 / $1,174.90