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Ohio 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
$900.52 / $2,451.00 / $8,956.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$730.12 / $972.06 / $1,631.71
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$846.08 / $1,208.69 / $1,301.66
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,145.00 / $2,792.00 / $8,800.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$655.59 / $875.70 / $1,549.11
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$808.60 / $1,177.43 / $1,177.43
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$719.64 / $1,022.74 / $1,022.74
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$21,571.00 / $21,571.00 / $21,571.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$738.81 / $1,087.81 / $1,823.30
Medical Mutual of Ohio
Facility/Professional
Professional
Modifier
Low / Median / High Price
$815.79 / $1,162.20 / $1,767.86
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$111.35 / $701.72 / $1,213.08
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,689.00 / $2,551.00 / $5,235.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$771.63 / $1,028.55 / $1,720.04