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New York rates for HCPCS 15120

Split-thickness 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 (except 15050)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$954.99 / $3,311.31 / $7,943.28
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$602.56 / $831.76 / $2,290.87
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,388.44 / $5,888.44 / $12,302.69
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$676.08 / $870.96 / $1,995.26
CDPHP
Facility/Professional
Facility
Modifier
Low / Median / High Price
$977.24 / $1,698.24 / $6,165.95
CDPHP
Facility/Professional
Professional
Modifier
Low / Median / High Price
$977.24 / $977.24 / $1,202.26
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,174.90 / $1,659.59 / $50,118.72
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$524.81 / $1,023.29 / $2,137.96
Emblem Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$616.60 / $812.83 / $2,398.83
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,023.29 / $1,230.27 / $1,995.26
Excellus BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$691.83 / $912.01 / $1,548.82
Highmark BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,630.78 / $5,370.32 / $11,748.98
MVP Health Care
Facility/Professional
Facility
Modifier
Low / Median / High Price
$794.33 / $50,118.72 / $75,857.76
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$398.11 / $1,000.00 / $1,288.25
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,344.23 / $5,128.61 / $11,481.54
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$457.09 / $812.83 / $1,737.80
Univera
Facility/Professional
Facility
Modifier
Low / Median / High Price
$562.34 / $741.31 / $2,570.40
Univera
Facility/Professional
Professional
Modifier
Low / Median / High Price
$691.83 / $977.24 / $2,290.87