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New Jersey rates for HCPCS 15240

Full thickness graft, free, including direct closure of donor site, forehead, cheeks, chin, mouth, neck, axillae, genitalia, hands, and/or feet; 20 sq cm or less

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,348.96 / $6,918.31 / $25,118.86
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$676.08 / $933.25 / $2,344.23
AmeriHealth
Facility/Professional
Professional
Modifier
Low / Median / High Price
$977.24 / $977.24 / $977.24
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$588.84 / $977.24 / $2,089.30
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,000.00 / $1,348.96 / $1,513.56
Horizon BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,168.69 / $5,128.61 / $9,120.11
Horizon BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$660.69 / $1,047.13 / $1,862.09
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,570.40 / $5,128.61 / $8,709.64
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$446.68 / $741.31 / $1,584.89