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Indiana rates for HCPCS 15200

Full thickness graft, free, including direct closure of donor site, trunk; 20 sq cm or less

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$554.00 / $1,123.00 / $11,093.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$554.00 / $682.63 / $783.41
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,754.00 / $5,948.00 / $9,462.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$572.78 / $688.61 / $1,010.79
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$543.13 / $791.12 / $1,031.63
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$756.18 / $907.42 / $1,083.21
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
$573.19 / $815.70 / $1,193.80
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,364.00 / $6,094.00 / $10,413.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$646.54 / $837.71 / $1,302.76