go back

New York rates for HCPCS 15201

Full thickness graft, free, including direct closure of donor site, trunk; each additional 20 sq cm, or part thereof (List separately in addition to code for primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.84 / $2,884.50 / $7,735.00
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,393.00 / $4,142.00 / $9,074.00
CDPHP
Facility/Professional
Facility
Modifier
Low / Median / High Price
$108.81 / $1,716.00 / $6,213.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$129.19 / $129.19 / $14,648.00
Emblem Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$70.00 / $116.18 / $332.00
MVP Health Care
Facility/Professional
Facility
Modifier
Low / Median / High Price
$129.19 / $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
$80.90 / $80.90 / $290.41