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Maryland 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
$56.23 / $2,454.71 / $5,011.87
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$602.56 / $851.14 / $2,290.87
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$645.65 / $724.44 / $891.25
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$645.65 / $831.76 / $1,479.11
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$831.76 / $1,023.29 / $1,778.28
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,023.29 / $1,023.29 / $2,238.72
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$616.60 / $851.14 / $1,548.82
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$676.08 / $933.25 / $1,412.54