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Colorado 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
$1,440.00 / $5,503.00 / $10,651.00
Denver HMP
Facility/Professional
Facility
Modifier
Low / Median / High Price
$138.30 / $222.18 / $352.13
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$153.46 / $216.81 / $402.91
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$730.00 / $1,464.00 / $3,011.00