go back

Indiana rates for HCPCS 15120

Split-thickness 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 (except 15050)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$776.25 / $1,380.38 / $7,244.36
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$588.84 / $776.25 / $1,737.80
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$549.54 / $549.54 / $549.54
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,344.23 / $13,803.84 / $19,054.61
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$660.69 / $954.99 / $1,412.54
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$691.83 / $691.83 / $707.95
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,630.27 / $2,630.27 / $2,630.27
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$616.60 / $891.25 / $1,348.96
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,090.30 / $7,762.47 / $10,964.78
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$562.34 / $812.83 / $1,288.25