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Rhode Island rates for HCPCS 15261

Full thickness graft, free, including direct closure of donor site, nose, ears, eyelids, and/or lips; 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
$2,090.73 / $2,778.87 / $3,955.04
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$104.65 / $164.61 / $227.12
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$139.02 / $197.96 / $302.48
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$142.90 / $222.23 / $431.20
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
$172.94 / $256.64 / $462.29