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Indiana rates for HCPCS 15100

Split-thickness autograft, trunk, arms, legs; first 100 sq cm or less, or 1% of body area of infants and children (except 15050)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$589.01 / $2,346.36 / $9,479.90
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$589.01 / $716.02 / $921.18
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,234.00 / $5,126.00 / $8,240.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$571.03 / $735.62 / $1,103.43
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$575.14 / $837.73 / $1,061.83
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$778.02 / $933.62 / $1,114.92
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,314.83 / $1,314.83 / $1,314.83
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$666.51 / $900.59 / $1,381.71
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,533.00 / $3,027.00 / $5,402.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$661.32 / $918.85 / $1,390.51