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Washington 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)

Facilitymedian $355 · 10th–90th $200–$16,2180%10%10th90th$355Professionalmedian $195 · 10th–90th $98–$4270%10%10th90th$195$10.0$50.0$200.0$1.0K$5.0K$20.0K

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$218.78 / $794.33 / $18,620.87
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$93.33 / $158.49 / $426.58
Asuris Northwest Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$724.44 / $724.44 / $724.44
Asuris Northwest Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$141.25 / $239.88 / $407.38
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$645.65 / $645.65 / $1,122.02
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$138.04 / $251.19 / $489.78
Kaiser Permanente
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$158.49 / $257.04 / $436.52
Kaiser Permanente
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$162.18 / $263.03 / $436.52
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$32.36 / $33.11 / $67.61
Pacific Source
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$218.78 / $338.84 / $354.81
Premera BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$234.42 / $234.42 / $239.88
Premera BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$144.54 / $239.88 / $426.58
Regence BlueShield
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$575.44 / $575.44 / $724.44
Regence BlueShield
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$141.25 / $234.42 / $371.54
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$141.25 / $645.65 / $5,754.40
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$138.04 / $229.09 / $389.05
Wellpoint
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$95.50 / $181.97 / $257.04