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Connecticut rates for HCPCS 15260

Full thickness graft, free, including direct closure of donor site, nose, ears, eyelids, and/or lips; 20 sq cm or less

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,280.50 / $4,769.00 / $7,629.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$745.70 / $1,094.01 / $3,677.89
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,788.00 / $6,273.00 / $10,956.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$798.18 / $1,119.40 / $1,452.87
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$907.85 / $1,287.83 / $2,096.98
ConnectiCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,058.39 / $1,300.74 / $1,551.06
Health New England
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,137.39 / $1,137.39 / $1,137.39
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,414.00 / $5,950.00 / $9,338.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$832.39 / $1,219.50 / $2,099.98