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Utah 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 $3,715 · 10th–90th $977–$6,4570%10%10th90th$3,715Professionalmedian $851 · 10th–90th $631–$2,5120%10%10th90th$851$50.0$200.0$1.0K$5.0K$20.0K

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
$977.24 / $3,715.35 / $6,025.60
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$630.96 / $831.76 / $2,511.89
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$812.83 / $1,047.13 / $1,318.26
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$32.36 / $33.11 / $3,090.30
Regence BlueShield
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$5,248.07 / $7,244.36 / $10,964.78
Regence BlueShield
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$758.58 / $1,047.13 / $1,862.09
Select Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$794.33 / $1,047.13 / $1,584.89
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$645.65 / $1,047.13 / $2,041.74
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,202.26 / $5,128.61 / $8,317.64
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$616.60 / $812.83 / $1,230.27