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Kentucky 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
$556.22 / $787.00 / $2,747.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$556.22 / $688.47 / $844.55
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,643.00 / $3,428.00 / $8,517.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$497.73 / $613.46 / $904.10
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$628.70 / $765.55 / $893.75
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$677.45 / $870.32 / $1,513.60
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$487.68 / $1,134.14 / $1,829.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$579.33 / $800.56 / $1,319.38
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.34 / $32.34 / $983.84
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$599.00 / $1,945.00 / $5,995.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$658.33 / $837.64 / $1,345.30