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Connecticut 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
$1,318.26 / $4,677.35 / $8,511.38
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$602.56 / $1,000.00 / $2,570.40
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,309.57 / $11,748.98 / $13,803.84
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$758.58 / $1,479.11 / $1,995.26
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$812.83 / $1,230.27 / $1,778.28
ConnectiCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,174.90 / $1,230.27 / $1,230.27
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,754.40 / $8,709.64 / $11,748.98
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$616.60 / $954.99 / $1,548.82