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Kansas 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
$1,000.00 / $3,388.44 / $7,943.28
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$616.60 / $812.83 / $1,659.59
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$660.69 / $660.69 / $660.69
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,548.82 / $3,630.78 / $3,801.89
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$977.24 / $977.24 / $1,174.90
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$446.68 / $446.68 / $446.68
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$707.95 / $1,023.29 / $1,513.56
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$724.44 / $1,174.90 / $9,549.93
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$831.76 / $1,000.00 / $6,309.57
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,862.09 / $2,884.03 / $6,309.57
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$724.44 / $933.25 / $1,258.93