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Idaho 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
$1,230.27 / $1,621.81 / $5,495.41
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$616.60 / $891.25 / $1,548.82
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,737.80 / $3,467.37 / $9,332.54
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,096.48 / $1,348.96 / $1,621.81
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$691.83 / $1,047.13 / $1,318.26
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$660.69 / $1,047.13 / $1,621.81
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$977.24 / $1,288.25 / $1,737.80
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $32.36 / $33.11
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,456.54 / $8,128.31 / $11,220.18
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,071.52 / $1,318.26 / $1,778.28
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$758.58 / $1,047.13 / $5,754.40
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$9,332.54 / $16,982.44 / $18,197.01
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$758.58 / $1,047.13 / $1,445.44