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Indiana rates for HCPCS 15760

Graft Composite W/Primary Closure Donor Area

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$582.26 / $1,073.79 / $7,212.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$582.26 / $704.94 / $792.54
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,234.00 / $5,126.00 / $8,240.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$619.34 / $728.64 / $1,092.96
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$567.08 / $825.99 / $1,046.01
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$767.20 / $920.64 / $1,098.31
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
$633.50 / $848.54 / $1,201.14
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
$653.40 / $888.07 / $1,483.57