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Ohio 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
$176.01 / $3,999.00 / $10,268.00
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$891.00 / $2,170.00 / $5,211.00
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$125.69 / $183.02 / $183.02
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$21,571.00 / $21,571.00 / $21,571.00
Medical Mutual of Ohio
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,373.38 / $1,373.38 / $1,373.38
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$444.00 / $975.00 / $2,914.00