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Indiana rates for HCPCS 15220

Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; 20 sq cm or less

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$505.26 / $936.94 / $7,212.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$505.26 / $632.14 / $762.18
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,234.00 / $5,126.00 / $8,240.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$518.52 / $649.75 / $954.03
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$494.80 / $720.72 / $950.87
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$696.66 / $835.99 / $998.42
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,314.83 / $1,314.83 / $1,314.83
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$563.44 / $755.83 / $1,178.27
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,403.00 / $3,870.00 / $6,474.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$589.75 / $753.59 / $1,209.76