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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
$851.14 / $4,073.80 / $8,317.64
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$691.83 / $912.01 / $2,238.72
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,801.89 / $4,466.84 / $57,543.99
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$912.01 / $1,513.56 / $1,737.80
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$691.83 / $933.25 / $1,513.56
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,122.02 / $1,445.44 / $1,584.89
Geisinger
Facility/Professional
Professional
Modifier
Low / Median / High Price
$758.58 / $1,122.02 / $1,659.59
Highmark BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,949.84 / $4,365.16 / $6,165.95
Highmark BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$794.33 / $794.33 / $933.25
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$851.14 / $3,801.89 / $7,762.47
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$707.95 / $1,023.29 / $2,187.76
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$812.83 / $812.83 / $812.83
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$478.63 / $794.33 / $912.01
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$478.63 / $776.25 / $912.01
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$912.01 / $2,754.23 / $6,606.93
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$660.69 / $912.01 / $1,621.81