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Indiana rates for HCPCS 15101

Split-thickness autograft, trunk, arms, legs; each additional 100 sq cm, or each additional 1% of body area of infants and children, or part thereof (List separately in addition to code for primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$90.28 / $201.04 / $11,093.00
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,140.00 / $5,948.00 / $10,303.00
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$87.05 / $126.80 / $225.19
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$933.00 / $2,252.00 / $4,426.00