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Colorado 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
$707.95 / $3,235.94 / $6,606.93
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$602.56 / $794.33 / $2,137.96
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,570.88 / $9,549.93 / $17,378.01
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$812.83 / $1,122.02 / $1,621.81
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$776.25 / $977.24 / $1,479.11
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$891.25 / $1,288.25 / $4,786.30
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$616.60 / $870.96 / $1,000.00
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,548.13 / $8,128.31 / $16,595.87
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$758.58 / $1,047.13 / $1,698.24