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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)

Facilitymedian $3,467 · 10th–90th $776–$8,5110%5%10th90th$3,467Professionalmedian $794 · 10th–90th $603–$1,7380%10%20%10th90th$794$100.0$500.0$2.0K$10.0K$50.0K

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$776.25 / $3,467.37 / $8,511.38
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$602.56 / $794.33 / $1,819.70
Capital Blue Cross
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$5,011.87 / $5,248.07 / $57,543.99
Capital Blue Cross
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$831.76 / $1,258.93 / $1,513.56
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$602.56 / $870.96 / $1,380.38
Emblem Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$891.25 / $1,348.96 / $1,513.56
Geisinger
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$776.25 / $1,047.13 / $1,479.11
Highmark BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$7,244.36 / $8,709.64 / $19,498.45
Highmark BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$912.01 / $912.01 / $912.01
Martin's Point
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$776.25 / $2,187.76 / $8,317.64
Martin's Point
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$602.56 / $831.76 / $1,621.81
Oscar Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$891.25 / $1,445.44 / $3,388.44
UPMC Health Plan
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$416.87 / $724.44 / $831.76
UPMC Health Plan
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$416.87 / $676.08 / $831.76
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$2,089.30 / $4,570.88 / $11,481.54
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$602.56 / $851.14 / $1,513.56