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Indiana rates for HCPCS 15201

Full thickness graft, free, including direct closure of donor site, trunk; each additional 20 sq cm, or part thereof (List separately in addition to code for primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$102.33 / $4,897.79 / $7,244.36
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$85.11 / $2,344.23 / $5,128.61
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$74.13 / $74.13 / $77.62
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$83.18 / $144.54 / $234.42
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$933.25 / $2,290.87 / $7,413.10