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Florida 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
$168.33 / $3,401.00 / $11,550.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$494.00 / $494.00 / $494.00
Florida Blue
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,297.33 / $1,383.82 / $1,496.26
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$366.00 / $1,950.00 / $4,970.00