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Georgia 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
$912.01 / $2,884.03 / $7,079.46
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$602.56 / $851.14 / $1,778.28
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$436.52 / $588.84 / $1,258.93
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,071.52 / $2,754.23 / $6,025.60
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$741.31 / $933.25 / $1,513.56
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$575.44 / $891.25 / $1,621.81
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$691.83 / $977.24 / $1,479.11
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$870.96 / $1,071.52 / $1,258.93
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,513.56 / $5,754.40 / $8,511.38
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$691.83 / $1,023.29 / $1,819.70