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Kentucky 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
$110.89 / $207.60 / $2,747.00
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,643.00 / $3,346.00 / $8,517.00
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$122.33 / $148.96 / $173.90
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$142.56 / $220.67 / $220.67
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$50.00 / $597.00 / $1,895.00