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Indiana rates for HCPCS 15275

Application of skin substitute graft to face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits, total wound surface area up to 100 sq cm; first 25 sq cm or less wound surface area

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$93.56 / $2,071.11 / $7,001.94
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$77.97 / $130.01 / $188.18
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,042.00 / $5,230.00 / $8,240.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$89.22 / $135.03 / $181.92
Anthem BCBS
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$133.83 / $202.55 / $272.88
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$85.58 / $102.70 / $119.81
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$144.03 / $158.43 / $194.44
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$119.21 / $119.21 / $119.21
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$104.40 / $152.22 / $219.18
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,400.00 / $3,870.00 / $5,490.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$121.26 / $161.68 / $277.00