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Alabama rates for HCPCS 15120

Split-thickness autograft, face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits; first 100 sq cm or less, or 1% of body area of infants and children (except 15050)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$645.65 / $1,258.93 / $2,398.83
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$616.60 / $812.83 / $1,548.82
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$562.34 / $562.34 / $660.69
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,691.53 / $3,235.94 / $4,365.16
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$724.44 / $1,000.00 / $1,174.90
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$537.03 / $794.33 / $2,511.89
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,122.02 / $3,630.78 / $5,128.61
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$549.54 / $724.44 / $954.99