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Pennsylvania 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
$717.83 / $3,066.00 / $7,606.34
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$681.76 / $829.46 / $1,511.85
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,736.00 / $4,444.00 / $15,949.31
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$918.14 / $1,475.33 / $1,674.13
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$693.95 / $930.50 / $1,631.36
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,099.38 / $1,413.49 / $1,457.62
Highmark BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,195.65 / $3,664.52 / $6,113.61
Highmark BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$761.85 / $892.12 / $927.81
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$848.48 / $3,838.00 / $7,799.00
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$712.10 / $916.35 / $1,799.45
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$818.10 / $818.10 / $861.80
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,336.65 / $1,336.65 / $1,336.65
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$725.15 / $944.44 / $1,656.90
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$770.11 / $800.92 / $918.21
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$769.01 / $881.28 / $960.93
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$637.00 / $2,391.00 / $6,000.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$783.63 / $968.02 / $1,720.37