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Virginia 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
$179.27 / $3,970.00 / $8,294.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$96.51 / $148.83 / $233.85
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$101.22 / $160.72 / $244.05
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$120.86 / $120.86 / $916.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$180.74 / $180.74 / $180.74
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$106.73 / $168.43 / $297.20
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$180.19 / $200.95 / $239.23
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$101.06 / $162.91 / $269.35
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$228.00 / $256.80 / $366.00
Sentara
Facility/Professional
Facility
Modifier
Low / Median / High Price
$107.95 / $149.21 / $1,098.00
Sentara
Facility/Professional
Professional
Modifier
Low / Median / High Price
$167.17 / $228.96 / $1,098.00
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$296.00 / $1,045.00 / $2,364.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$141.47 / $194.23 / $331.66