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New Jersey rates for HCPCS 15200

Full thickness graft, free, including direct closure of donor site, trunk; 20 sq cm or less

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$617.55 / $5,956.00 / $10,692.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$568.78 / $705.86 / $1,395.50
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$432.27 / $852.87 / $1,669.12
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$881.63 / $1,195.09 / $1,335.65
Horizon BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,588.91 / $4,283.18 / $9,643.75
Horizon BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$632.91 / $887.46 / $1,322.95
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
$474.31 / $821.92 / $1,602.55