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Washington 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 $2,188 · 10th–90th $1,122–$13,8040%5%10%10th90th$2,188Professionalmedian $977 · 10th–90th $646–$2,0420%10%10th90th$977$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
$1,122.02 / $4,677.35 / $17,782.79
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$630.96 / $891.25 / $1,862.09
Ambetter
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$575.44 / $575.44 / $758.58
Asuris Northwest Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$6,760.83 / $9,549.93 / $19,498.45
Asuris Northwest Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$933.25 / $1,318.26 / $2,137.96
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$562.34 / $912.01 / $4,677.35
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$831.76 / $1,318.26 / $2,344.23
Kaiser Permanente
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,023.29 / $1,621.81 / $4,570.88
Kaiser Permanente
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,023.29 / $1,584.89 / $2,398.83
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$32.36 / $33.11 / $309.03
Pacific Source
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,047.13 / $1,621.81 / $1,698.24
Premera BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,148.15 / $1,174.90 / $1,318.26
Premera BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$954.99 / $1,318.26 / $2,089.30
Regence BlueShield
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$6,760.83 / $10,000.00 / $19,498.45
Regence BlueShield
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$933.25 / $1,318.26 / $1,995.26
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$2,951.21 / $11,220.18 / $20,417.38
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$870.96 / $1,148.15 / $2,089.30
Wellpoint
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$676.08 / $1,000.00 / $1,288.25