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New York rates for HCPCS 15241

Full thickness graft, free, including direct closure of donor site, forehead, cheeks, chin, mouth, neck, axillae, genitalia, hands, and/or feet; 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
$145.02 / $3,818.00 / $9,523.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$94.81 / $158.05 / $309.92
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,263.00 / $5,196.00 / $11,909.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$117.38 / $169.16 / $369.28
CDPHP
Facility/Professional
Facility
Modifier
Low / Median / High Price
$148.97 / $1,990.00 / $8,917.50
CDPHP
Facility/Professional
Professional
Modifier
Low / Median / High Price
$148.97 / $148.97 / $251.63
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$180.74 / $180.74 / $14,648.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$92.11 / $187.25 / $397.11
Emblem Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$99.00 / $163.28 / $332.00
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$201.55 / $238.20 / $493.04
Excellus BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$145.74 / $166.04 / $366.33
MVP Health Care
Facility/Professional
Facility
Modifier
Low / Median / High Price
$180.74 / $555.00 / $74,999.25
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$110.87 / $217.02 / $470.63
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$964.00 / $2,826.00 / $4,851.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$116.74 / $192.05 / $459.82
Univera
Facility/Professional
Facility
Modifier
Low / Median / High Price
$113.67 / $113.67 / $410.30
Univera
Facility/Professional
Professional
Modifier
Low / Median / High Price
$141.21 / $171.46 / $366.33