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Utah 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 $3,388 · 10th–90th $151–$4,8980%10%20%10th90th$3,388Professionalmedian $174 · 10th–90th $93–$2880%10%10th90th$174$50.0$100.0$200.0$500.0$1.0K$2.0K$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
$151.36 / $3,388.44 / $4,897.79
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$93.33 / $173.78 / $288.40
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$660.69 / $4,466.84 / $5,128.61