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Indiana rates for HCPCS 15277

Application of skin substitute graft to face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits, 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
$183.98 / $731.00 / $7,212.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$183.98 / $248.60 / $323.81
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
$190.45 / $261.23 / $369.51
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$177.59 / $258.67 / $416.42
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$304.26 / $323.27 / $437.24
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,314.83 / $1,314.83 / $1,314.83
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$227.39 / $329.25 / $483.71
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
$264.99 / $365.25 / $588.86