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Pennsylvania rates for HCPCS 15201

Full thickness graft, free, including direct closure of donor site, trunk; each additional 20 sq cm, or part thereof (List separately in addition to code for primary procedure)

Facilitymedian $3,631 · 10th–90th $132$8,3180%5%10%10th90th$3,631$100.0$500.0$2.0K$10.0K$50.0K

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
$131.83 / $3,715.35 / $8,317.64
Capital Blue Cross
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$3,801.89 / $4,466.84 / $57,543.99
Martin's Point
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$575.44 / $2,454.71 / $8,317.64
UPMC Health Plan
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$74.13 / $138.04 / $407.38
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$162.18 / $575.44 / $4,466.84