go back

New York rates for HCPCS 15111

Epidermal 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
$127.36 / $2,902.00 / $7,563.00
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,393.00 / $4,142.00 / $9,074.00
CDPHP
Facility/Professional
Facility
Modifier
Low / Median / High Price
$143.06 / $1,254.00 / $4,050.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$173.66 / $173.66 / $14,648.00
Emblem Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$94.00 / $154.54 / $332.00
MVP Health Care
Facility/Professional
Facility
Modifier
Low / Median / High Price
$173.66 / $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
$107.10 / $107.10 / $395.98