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Ohio rates for HCPCS 15200

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

Facilitymedian $4,169 · 10th–90th $891$10,7150%10%10th90th$4,169Professionalmedian $759 · 10th–90th $575$1,7780%20%10th90th$759$10.0$50.0$200.0$1.0K$5.0K$20.0K

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$851.14 / $4,570.88 / $10,964.78
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$588.84 / $741.31 / $2,187.76
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,000.00 / $3,019.95 / $7,943.28
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$562.34 / $758.58 / $1,258.93
CareSource
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$645.65 / $645.65 / $645.65
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$21,379.62 / $21,379.62 / $21,379.62
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$616.60 / $933.25 / $1,584.89
Medical Mutual of Ohio
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$21,379.62 / $21,379.62 / $21,379.62
Medical Mutual of Ohio
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$616.60 / $954.99 / $1,445.44
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$32.36 / $33.11 / $426.58
SummaCare
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$100.00 / $100.00 / $1,258.93
SummaCare
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$616.60 / $912.01 / $1,659.59
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,548.82 / $4,265.80 / $7,244.36
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$562.34 / $794.33 / $1,288.25