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Rhode Island 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
$2,424.15 / $3,243.94 / $3,955.04
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$82.54 / $142.21 / $194.73
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$109.81 / $153.03 / $245.27
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$110.45 / $186.41 / $364.15
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$540.00 / $1,401.00 / $4,915.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$140.21 / $222.58 / $346.61