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New Jersey rates for HCPCS 15130

Dermal autograft, trunk, arms, legs; 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
$518.84 / $5,122.00 / $10,202.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$478.71 / $574.91 / $1,067.45
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$384.91 / $703.94 / $1,359.39
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$756.69 / $1,025.74 / $1,145.08
Horizon BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,707.40 / $4,447.22 / $9,643.75
Horizon BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$564.22 / $773.72 / $1,071.26
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,415.00 / $7,250.00 / $10,536.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$396.70 / $709.84 / $1,383.31