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Ohio 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
$174.73 / $2,849.00 / $10,268.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$116.87 / $174.73 / $308.14
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$772.00 / $2,141.00 / $3,111.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$136.22 / $200.21 / $338.21
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$129.01 / $187.85 / $187.85
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$195.35 / $206.55 / $206.55
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
$123.95 / $201.18 / $341.61
Medical Mutual of Ohio
Facility/Professional
Professional
Modifier
Low / Median / High Price
$132.80 / $214.23 / $322.79
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$163.59 / $220.27 / $311.05
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$444.00 / $975.00 / $2,914.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$163.34 / $227.86 / $417.33