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Michigan 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
$1,071.52 / $4,073.80 / $8,317.64
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$691.83 / $954.99 / $2,041.74
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,202.26 / $1,202.26 / $1,202.26
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$707.95 / $1,202.26 / $1,479.11
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$660.69 / $933.25 / $3,715.35
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,000.00 / $4,073.80 / $8,317.64
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$741.31 / $1,047.13 / $1,621.81
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$660.69 / $851.14 / $3,388.44
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,445.44 / $3,235.94 / $6,309.57
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$776.25 / $954.99 / $1,288.25