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Indiana rates for HCPCS 15261

Full thickness graft, free, including direct closure of donor site, nose, ears, eyelids, and/or lips; 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
$181.97 / $4,897.79 / $7,244.36
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$114.82 / $173.78 / $407.38
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$151.36 / $2,344.23 / $5,128.61
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$131.83 / $204.17 / $331.13
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$134.90 / $134.90 / $138.04
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$138.04 / $208.93 / $331.13
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$933.25 / $2,290.87 / $7,413.10
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$114.82 / $181.97 / $302.00