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Virginia 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)

Facilitymedian $1,230 · 10th–90th $151–$7,9430%5%10th90th$1,230Professionalmedian $263 · 10th–90th $200–$3980%20%10th90th$263$100.0$200.0$500.0$1.0K$2.0K$5.0K$10.0K

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Small sample — interpret with caution. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$218.78 / $4,786.30 / $8,317.64
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$218.78 / $218.78 / $218.78
Kaiser Permanente
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$199.53 / $263.03 / $316.23
Medcost
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$398.11 / $398.11 / $457.09
Medcost
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$128.82 / $223.87 / $380.19
Sentara
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$125.89 / $199.53 / $4,073.80
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$204.17 / $1,047.13 / $2,344.23