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New York rates for HCPCS 15260

Full thickness graft, free, including direct closure of donor site, nose, ears, eyelids, and/or lips; 20 sq cm or less

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,009.84 / $3,756.00 / $11,326.97
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$745.70 / $913.50 / $1,950.78
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,393.00 / $4,142.00 / $9,074.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$751.89 / $939.04 / $2,194.00
CDPHP
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,181.04 / $1,716.00 / $6,213.00
CDPHP
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,181.04 / $1,181.04 / $1,404.97
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,423.37 / $1,423.37 / $1,423.37
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$619.02 / $1,200.07 / $2,829.61
Emblem Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$332.00 / $899.82 / $2,191.10
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,172.79 / $1,359.37 / $3,190.21
Excellus BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$758.14 / $1,077.10 / $1,853.91
Highmark BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,832.16 / $3,024.26 / $5,904.46
Highmark BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,002.94 / $1,211.02 / $1,637.52
MVP Health Care
Facility/Professional
Facility
Modifier
Low / Median / High Price
$555.00 / $1,423.37 / $74,999.25
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$733.34 / $1,260.42 / $3,071.90
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,764.00 / $3,961.00 / $8,312.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$616.23 / $1,124.98 / $2,478.69
Univera
Facility/Professional
Facility
Modifier
Low / Median / High Price
$908.86 / $908.86 / $2,647.92
Univera
Facility/Professional
Professional
Modifier
Low / Median / High Price
$758.14 / $1,077.10 / $2,406.83