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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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$630.96 / $4,168.69 / $7,943.28
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$602.56 / $851.14 / $2,041.74
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$794.33 / $1,096.48 / $1,445.44
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $33.11 / $2,754.23
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,818.38 / $3,311.31 / $7,244.36
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$891.25 / $1,230.27 / $2,137.96
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$851.14 / $1,148.15 / $1,737.80
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$977.24 / $1,202.26 / $1,949.84
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,698.24 / $4,466.84 / $5,128.61
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$676.08 / $870.96 / $1,318.26