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Indiana rates for HCPCS 15150

Tissue cultured skin autograft, trunk, arms, legs; first 25 sq cm or less

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$519.78 / $959.23 / $7,212.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$519.78 / $576.10 / $685.71
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
$552.61 / $660.22 / $978.87
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$506.57 / $737.87 / $851.08
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$623.95 / $748.74 / $893.63
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
$589.45 / $749.82 / $1,119.33
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
$549.47 / $710.64 / $1,142.58