go back

Michigan 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
$851.14 / $2,884.03 / $4,897.79
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$602.56 / $812.83 / $1,862.09
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$660.69 / $660.69 / $660.69
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$645.65 / $1,047.13 / $1,047.13
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$218.78 / $1,047.13 / $1,348.96
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$602.56 / $870.96 / $3,235.94
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$851.14 / $2,570.40 / $4,897.79
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$676.08 / $954.99 / $1,513.56
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$575.44 / $812.83 / $2,884.03
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,884.03 / $5,888.44 / $10,000.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$707.95 / $891.25 / $1,258.93