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Ohio 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
$117.35 / $2,936.00 / $9,534.00
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$772.00 / $2,141.00 / $3,111.00
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$73.40 / $106.89 / $106.89
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$21,571.00 / $21,571.00 / $21,571.00
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$444.00 / $975.00 / $2,914.00