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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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$721.47 / $3,999.00 / $10,268.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$583.10 / $721.47 / $1,393.84
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,152.00 / $3,025.00 / $8,800.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$490.69 / $722.79 / $1,246.38
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$645.79 / $940.36 / $940.36
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$609.99 / $856.89 / $856.89
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$21,571.00 / $21,571.00 / $21,571.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$591.97 / $871.30 / $1,456.19
Medical Mutual of Ohio
Facility/Professional
Professional
Modifier
Low / Median / High Price
$664.78 / $949.69 / $1,400.90
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$75.89 / $575.63 / $1,022.47
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,233.00 / $4,138.00 / $6,522.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$630.66 / $863.62 / $1,444.52