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New Jersey rates for HCPCS 15274

Application of skin substitute graft to trunk, arms, legs, total wound surface area greater than or equal to 100 sq cm; each additional 100 sq cm wound surface area, or part thereof, or each additional 1% of body area of infants and children, or part thereof (List separately in addition to code for primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$57.16 / $4,294.00 / $9,860.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$37.84 / $58.81 / $114.49
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$40.06 / $68.27 / $128.11
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$83.31 / $112.94 / $125.73
Horizon BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$42.43 / $77.76 / $113.48
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,529.00 / $3,352.00 / $10,536.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$41.89 / $75.08 / $151.53