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New York 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)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$208.93 / $3,890.45 / $9,332.54
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,388.44 / $5,888.44 / $12,302.69
CDPHP
Facility/Professional
Facility
Modifier
Low / Median / High Price
$190.55 / $1,995.26 / $8,912.51
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$218.78 / $1,862.09 / $50,118.72
Emblem Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$144.54 / $190.55 / $467.74
MVP Health Care
Facility/Professional
Facility
Modifier
Low / Median / High Price
$181.97 / $50,118.72 / $75,857.76
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,258.93 / $2,754.23 / $4,897.79
Univera
Facility/Professional
Facility
Modifier
Low / Median / High Price
$104.71 / $138.04 / $660.69