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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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$701.40 / $3,038.00 / $7,568.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$503.63 / $701.40 / $1,266.77
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$695.16 / $974.33 / $1,321.23
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$61.32 / $478.54 / $777.02
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,814.80 / $3,509.81 / $5,038.84
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$747.23 / $934.31 / $1,438.73
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,981.00 / $3,613.00 / $7,048.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$690.90 / $843.20 / $1,255.59