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Utah rates for HCPCS 15260

Full thickness graft, free, including direct closure of donor site, nose, ears, eyelids, and/or lips; 20 sq cm or less

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,047.13 / $3,235.94 / $6,025.60
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$645.65 / $912.01 / $2,137.96
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$851.14 / $1,174.90 / $1,548.82
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $33.11 / $2,511.89
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,818.38 / $3,311.31 / $7,244.36
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$933.25 / $1,288.25 / $1,737.80
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$912.01 / $1,230.27 / $1,862.09
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,023.29 / $1,288.25 / $1,862.09
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,698.24 / $4,466.84 / $5,128.61
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$724.44 / $933.25 / $1,412.54