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Rhode Island 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
$2,089.30 / $4,677.35 / $8,511.38
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$645.65 / $891.25 / $2,454.71
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$537.03 / $724.44 / $1,174.90
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$776.25 / $1,047.13 / $1,819.70
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,818.38 / $5,128.61 / $10,000.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$602.56 / $1,000.00 / $1,584.89