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Virginia 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
$212.66 / $3,116.00 / $8,294.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$128.49 / $177.87 / $238.35
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$127.57 / $194.50 / $286.52
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$153.08 / $153.08 / $916.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$227.39 / $227.39 / $227.39
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$136.52 / $205.37 / $373.98
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$212.66 / $236.87 / $281.99
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$133.38 / $201.17 / $310.04
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$265.00 / $303.00 / $429.00
Sentara
Facility/Professional
Facility
Modifier
Low / Median / High Price
$138.99 / $189.14 / $1,098.00
Sentara
Facility/Professional
Professional
Modifier
Low / Median / High Price
$196.53 / $266.88 / $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
$164.24 / $223.14 / $384.09