go back

Washington, DC 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
$217.77 / $2,986.00 / $6,456.00
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$246.32 / $481.14 / $572.91
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$165.00 / $442.00 / $5,940.00