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Georgia 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
$185.89 / $4,592.00 / $6,915.00
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$822.79 / $1,791.76 / $3,132.87
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$141.58 / $220.34 / $548.66
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$353.00 / $1,580.00 / $2,665.00