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Indiana rates for HCPCS 15240

Full thickness graft, free, including direct closure of donor site, forehead, cheeks, chin, mouth, neck, axillae, genitalia, hands, and/or feet; 20 sq cm or less

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$891.25 / $4,897.79 / $12,302.69
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$660.69 / $912.01 / $1,949.84
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$549.54 / $616.60 / $977.24
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,715.35 / $8,317.64 / $10,471.29
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$645.65 / $933.25 / $1,445.44
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$794.33 / $794.33 / $794.33
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$831.76 / $1,000.00 / $1,479.11
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$588.84 / $912.01 / $1,288.25
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,548.82 / $3,715.35 / $6,456.54
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$616.60 / $870.96 / $1,380.38