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New York rates for HCPCS 15101

Split-thickness autograft, trunk, arms, legs; 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
$147.65 / $3,783.00 / $9,868.00
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,263.00 / $5,196.00 / $11,909.00
CDPHP
Facility/Professional
Facility
Modifier
Low / Median / High Price
$157.97 / $1,990.00 / $8,917.50
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$186.21 / $186.21 / $14,648.00
Emblem Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$103.00 / $167.82 / $332.00
Highmark BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,765.42 / $3,765.42 / $3,765.42
MVP Health Care
Facility/Professional
Facility
Modifier
Low / Median / High Price
$186.21 / $555.00 / $74,999.25
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$964.00 / $2,826.00 / $4,851.00
Univera
Facility/Professional
Facility
Modifier
Low / Median / High Price
$117.09 / $117.09 / $425.47