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Utah 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)

Facilitymedian $3,388 · 10th–90th $224–$4,8980%10%20%10th90th$3,388Professionalmedian $191 · 10th–90th $126–$5890%10%10th90th$191$50.0$100.0$200.0$500.0$1.0K$2.0K$5.0K

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
$223.87 / $3,388.44 / $4,897.79
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$123.03 / $190.55 / $724.44
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$158.49 / $229.09 / $331.13
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$32.36 / $33.11 / $616.60
Regence BlueShield
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$147.91 / $229.09 / $354.81
Select Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$151.36 / $251.19 / $389.05
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$162.18 / $257.04 / $407.38
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$660.69 / $4,466.84 / $5,128.61
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$123.03 / $186.21 / $288.40