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Pennsylvania rates for HCPCS 15241

Full thickness graft, free, including direct closure of donor site, forehead, cheeks, chin, mouth, neck, axillae, genitalia, hands, and/or feet; each additional 20 sq cm, or part thereof (List separately in addition to code for primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$160.41 / $3,745.00 / $7,629.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$91.38 / $143.16 / $204.20
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,299.82 / $2,746.00 / $13,822.74
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$169.28 / $175.67 / $328.86
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$100.69 / $163.18 / $273.58
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$203.58 / $261.75 / $270.27
Highmark BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$173.25 / $173.25 / $173.25
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$832.00 / $3,964.00 / $8,017.00
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$94.93 / $160.41 / $963.48
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$169.40 / $169.40 / $178.40
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$180.74 / $180.74 / $180.74
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$103.71 / $166.62 / $281.05
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$102.60 / $117.71 / $181.16
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$102.60 / $164.29 / $179.57
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$144.00 / $650.00 / $4,300.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$152.69 / $188.61 / $348.11