go back

Indiana rates for HCPCS 15115

Epidermal autograft, face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits; first 100 sq cm or less, or 1% of body area of infants and children

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$572.40 / $1,073.78 / $7,212.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$572.40 / $667.11 / $750.41
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
$627.24 / $768.25 / $1,113.64
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$567.07 / $825.98 / $996.49
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$734.68 / $881.62 / $1,046.31
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
$658.41 / $861.82 / $1,295.26
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,403.00 / $3,870.00 / $6,474.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$620.54 / $824.29 / $1,267.96