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California rates for HCPCS 15121

Split-thickness autograft, face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits; each additional 100 sq cm, or each additional 1% of body area of infants and children, or part thereof (List separately in addition to code for primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$267.14 / $6,229.00 / $17,030.00
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,787.00 / $4,539.00 / $9,381.00
Blue Shield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$65.80 / $100.00 / $7,919.07
Contra Costa Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$84.51 / $167.60 / $297.17
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$131.10 / $213.97 / $386.47
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$594.91 / $2,000.00 / $26,542.00
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$145.74 / $235.14 / $397.29
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$587.00 / $1,533.00 / $5,691.00