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Utah 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
$121.21 / $3,294.00 / $7,568.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$89.02 / $148.83 / $963.48
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$125.34 / $168.52 / $272.80
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$117.29 / $151.64 / $186.27
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$117.34 / $190.31 / $285.73
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,078.00 / $1,556.00 / $4,495.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$149.55 / $186.48 / $290.19