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Indiana rates for HCPCS 15274

Application of skin substitute graft to trunk, arms, legs, total wound surface area greater than or equal to 100 sq cm; each additional 100 sq cm wound surface area, or part thereof, or each additional 1% of body area of infants and children, or part thereof (List separately in addition to code for primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$36.32 / $119.55 / $5,634.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$36.32 / $58.55 / $78.20
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$46.06 / $949.00 / $2,956.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$39.15 / $60.79 / $82.41
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$34.65 / $50.48 / $98.51
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$70.73 / $75.16 / $103.43
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$47.22 / $71.09 / $112.71
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$933.00 / $2,252.00 / $4,426.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$61.02 / $78.61 / $128.11