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California rates for HCPCS 15240

Full thickness graft, free, including direct closure of donor site, forehead, cheeks, chin, mouth, neck, axillae, genitalia, hands, and/or feet; 20 sq cm or less

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,818.38 / $7,079.46 / $18,620.87
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$676.08 / $891.25 / $2,691.53
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$562.34 / $562.34 / $562.34
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,570.88 / $8,128.31 / $15,848.93
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$724.44 / $1,000.00 / $2,570.40
Blue Shield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$66.07 / $2,398.83 / $8,709.64
Blue Shield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$676.08 / $933.25 / $2,089.30
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$724.44 / $1,023.29 / $1,949.84
Contra Costa Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$338.84 / $954.99 / $1,412.54
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$707.95 / $1,047.13 / $1,819.70
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,623.41 / $45,708.82 / $45,708.82
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6,760.83 / $7,943.28 / $7,943.28
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$794.33 / $794.33 / $1,318.26
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$707.95 / $954.99 / $1,445.44
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$724.44 / $1,023.29 / $1,995.26
Sutter Health Plus
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,630.27 / $2,630.27 / $3,090.30
The Alliance
Facility/Professional
Professional
Modifier
Low / Median / High Price
$426.58 / $630.96 / $1,023.29
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,344.23 / $4,365.16 / $10,000.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$645.65 / $870.96 / $1,737.80