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New Jersey rates for HCPCS 15277

Application of skin substitute graft to face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits, total wound surface area greater than or equal to 100 sq cm; first 100 sq cm wound surface area, or 1% of body area of infants and children

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$248.60 / $5,009.00 / $9,842.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$183.09 / $263.72 / $520.83
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$160.41 / $329.81 / $575.35
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$355.30 / $481.63 / $535.76
Horizon BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,075.77 / $8,481.31 / $9,643.75
Horizon BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$212.74 / $352.18 / $490.23
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,705.00 / $5,265.00 / $10,536.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$189.49 / $305.19 / $652.92