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Iowa 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
$1,023.29 / $4,265.80 / $15,135.61
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$616.60 / $933.25 / $3,235.94
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,584.89 / $1,949.84 / $2,454.71
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$630.96 / $1,122.02 / $2,570.40
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$977.24 / $1,995.26 / $9,332.54
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$954.99 / $1,621.81 / $2,818.38
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,513.56 / $1,862.09 / $2,290.87
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,786.30 / $7,762.47 / $10,715.19
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$758.58 / $1,122.02 / $2,089.30
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,202.26 / $1,445.44 / $1,778.28