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New York rates for HCPCS 15152

Tissue cultured skin 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
$169.51 / $2,902.00 / $7,563.00
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,691.00 / $3,382.00 / $4,707.00
CDPHP
Facility/Professional
Facility
Modifier
Low / Median / High Price
$192.70 / $1,254.00 / $4,050.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$245.42 / $245.42 / $14,648.00
Emblem Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$127.00 / $212.22 / $380.50
MVP Health Care
Facility/Professional
Facility
Modifier
Low / Median / High Price
$245.42 / $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
$146.84 / $146.84 / $533.97