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Utah 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

Facilitymedian $4,169 · 10th–90th $631–$7,9430%10%10th90th$4,169Professionalmedian $891 · 10th–90th $513–$2,0420%10%10th90th$891$50.0$200.0$1.0K$5.0K

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$630.96 / $4,168.69 / $7,943.28
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$501.19 / $851.14 / $2,089.30
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$870.96 / $1,148.15 / $1,479.11
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$32.36 / $33.11 / $2,754.23
Regence BlueShield
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$2,630.27 / $3,548.13 / $5,495.41
Regence BlueShield
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$891.25 / $1,202.26 / $2,041.74
Select Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$870.96 / $1,148.15 / $1,737.80
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$724.44 / $1,202.26 / $1,862.09
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$870.96 / $4,466.84 / $5,128.61
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$676.08 / $870.96 / $1,318.26