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Kentucky 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
$72.44 / $1,513.56 / $5,495.41
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,479.11 / $2,398.83 / $4,365.16
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$67.61 / $87.10 / $102.33
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$128.82 / $128.82 / $1,659.59
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$50.12 / $602.56 / $3,162.28