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Iowa 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
$3,468.00 / $4,917.20 / $8,042.03
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$127.05 / $280.79 / $777.88
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$197.91 / $371.33 / $1,607.00
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$286.02 / $447.59 / $661.14
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,204.00 / $1,623.00 / $2,126.00