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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
$72.81 / $135.60 / $5,320.00
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,258.00 / $2,191.00 / $4,066.00
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$71.63 / $87.21 / $101.82
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$72.97 / $129.19 / $129.19
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$50.00 / $597.00 / $1,895.00