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Florida 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 / $3,548.13 / $8,709.64
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$602.56 / $812.83 / $1,819.70
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$562.34 / $660.69 / $1,122.02
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$436.52 / $1,949.84 / $2,344.23
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$575.44 / $812.83 / $1,348.96
Florida Blue
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,165.95 / $12,022.64 / $22,908.68
Florida Blue
Facility/Professional
Professional
Modifier
Low / Median / High Price
$616.60 / $691.83 / $1,000.00
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $707.95 / $1,288.25
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,630.27 / $7,585.78 / $12,022.64
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$549.54 / $758.58 / $1,380.38
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$537.03 / $645.65 / $812.83