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Wyoming 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
Professional
Modifier
Low / Median / High Price
$630.96 / $812.83 / $1,737.80
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,230.27 / $1,621.81 / $1,995.26
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$794.33 / $1,047.13 / $1,548.82
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,162.28 / $4,168.69 / $14,125.38
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$831.76 / $1,230.27 / $2,691.53