go back

Indiana rates for HCPCS 15273

Application of skin substitute graft to trunk, arms, legs, total wound surface area greater than or equal to 100 sq cm; first 100 sq cm wound surface area, or 1% of body area of infants and children

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$160.19 / $731.00 / $7,212.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$160.19 / $245.63 / $319.11
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,153.00 / $7,522.00 / $18,942.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$183.06 / $258.23 / $347.89
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$154.05 / $224.38 / $377.11
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$271.92 / $326.30 / $395.96
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,623.15 / $2,623.15 / $2,623.15
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$203.15 / $298.18 / $432.34
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,932.00 / $8,025.00 / $11,038.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$241.71 / $322.27 / $538.78