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Indiana rates for HCPCS 15121

Split-thickness autograft, face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits; 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
$109.19 / $497.76 / $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
$103.82 / $151.22 / $251.86
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$933.00 / $2,252.00 / $4,426.00