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Iowa 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
$3,152.06 / $4,604.83 / $8,042.03
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$809.94 / $1,197.36 / $2,275.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,087.53 / $2,124.55 / $2,677.18
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$726.44 / $1,223.72 / $2,081.92
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,058.93 / $1,894.98 / $5,023.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$978.98 / $1,831.23 / $5,921.68
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,415.00 / $1,840.11 / $2,423.55
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,295.00 / $1,964.53 / $2,494.46
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,044.00 / $5,023.00 / $7,305.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$924.00 / $1,320.00 / $2,329.31
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,314.72 / $1,664.20 / $1,957.90