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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)

Facilitymedian $4,786 · 10th–90th $1,349–$13,4900%10%10th90th$4,786Professionalmedian $234 · 10th–90th $120–$4270%5%10%10th90th$234$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
$2,691.53 / $7,244.36 / $18,197.01
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$2,570.40 / $4,466.84 / $12,882.50
Blue Shield
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$85.11 / $5,248.07 / $10,471.29
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$218.78 / $218.78 / $218.78
Contra Costa Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$85.11 / $154.88 / $316.23
Kaiser Permanente
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$120.23 / $234.42 / $426.58
Lucent Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,995.26 / $45,708.82 / $45,708.82
Providence
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$125.89 / $223.87 / $407.38
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$575.44 / $1,584.89 / $6,760.83