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Pennsylvania 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
$776.25 / $3,467.37 / $8,511.38
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$602.56 / $812.83 / $2,290.87
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$660.69 / $660.69 / $660.69
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,011.87 / $5,248.07 / $57,543.99
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$831.76 / $1,380.38 / $1,621.81
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$630.96 / $851.14 / $1,380.38
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,047.13 / $1,348.96 / $1,513.56
Geisinger
Facility/Professional
Professional
Modifier
Low / Median / High Price
$758.58 / $1,096.48 / $1,584.89
Highmark BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7,244.36 / $8,709.64 / $19,498.45
Highmark BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$912.01 / $912.01 / $912.01
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$891.25 / $2,570.40 / $8,317.64
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$630.96 / $933.25 / $2,137.96
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$851.14 / $851.14 / $851.14
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$416.87 / $676.08 / $831.76
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$416.87 / $676.08 / $870.96
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,698.24 / $3,981.07 / $10,964.78
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$616.60 / $851.14 / $1,513.56