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New York rates for HCPCS 15115

Epidermal autograft, face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits; first 100 sq cm or less, or 1% of body area of infants and children

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$841.23 / $3,599.00 / $8,442.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$619.77 / $730.73 / $1,502.21
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,393.00 / $4,142.00 / $9,074.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$631.66 / $768.25 / $1,639.18
CDPHP
Facility/Professional
Facility
Modifier
Low / Median / High Price
$975.24 / $1,716.00 / $6,213.00
CDPHP
Facility/Professional
Professional
Modifier
Low / Median / High Price
$975.24 / $975.24 / $1,146.16
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,191.29 / $1,191.29 / $1,191.29
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$516.35 / $987.78 / $2,128.03
Emblem Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$332.00 / $744.59 / $1,827.59
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$950.09 / $1,103.31 / $2,325.55
Excellus BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$679.75 / $785.46 / $1,495.45
MVP Health Care
Facility/Professional
Facility
Modifier
Low / Median / High Price
$555.00 / $1,191.29 / $74,999.25
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$601.48 / $1,033.04 / $2,245.35
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,883.00 / $3,670.00 / $7,203.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$539.50 / $941.08 / $2,049.80
Univera
Facility/Professional
Facility
Modifier
Low / Median / High Price
$747.71 / $747.71 / $2,496.66
Univera
Facility/Professional
Professional
Modifier
Low / Median / High Price
$683.38 / $868.85 / $2,202.44