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Virginia 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 $1,514 · 10th–90th $776–$7,2440%5%10th90th$1,514Professionalmedian $891 · 10th–90th $646–$1,6600%10%10th90th$891$500.0$1.0K$2.0K$5.0K$10.0K$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
$776.25 / $1,548.82 / $6,918.31
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$645.65 / $870.96 / $1,659.59
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$5,888.44 / $6,760.83 / $7,413.10
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$707.95 / $1,000.00 / $1,479.11
CareFirst
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$645.65 / $776.25 / $5,495.41
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,174.90 / $1,174.90 / $1,174.90
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$676.08 / $933.25 / $1,479.11
Kaiser Permanente
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$794.33 / $1,023.29 / $1,230.27
Medcost
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,122.02 / $1,122.02 / $1,348.96
Medcost
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$645.65 / $912.01 / $1,412.54
Medcost
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$4,265.80 / $4,265.80 / $4,265.80
Sentara
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$660.69 / $954.99 / $10,000.00
Sentara
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$776.25 / $1,148.15 / $10,000.00
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$5,248.07 / $8,317.64 / $17,378.01
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$602.56 / $870.96 / $1,479.11