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Indiana rates for HCPCS 15221

Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; 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
$56.61 / $311.05 / $7,212.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$56.61 / $106.02 / $121.97
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,804.00 / $4,417.00 / $7,761.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$62.00 / $101.70 / $155.16
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$54.86 / $79.91 / $157.77
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$113.66 / $136.38 / $165.66
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$69.97 / $116.46 / $182.54
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$933.00 / $2,252.00 / $4,426.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$102.56 / $140.69 / $221.36