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Delaware 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
$1,548.82 / $1,905.46 / $8,317.64
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$676.08 / $1,148.15 / $2,041.74
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$645.65 / $851.14 / $1,230.27
Highmark BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,495.41 / $6,025.60 / $16,595.87
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$616.60 / $870.96 / $1,621.81