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New York 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
$285.17 / $2,942.87 / $7,839.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$196.12 / $277.94 / $580.29
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
$224.06 / $303.45 / $657.30
CDPHP
Facility/Professional
Facility
Modifier
Low / Median / High Price
$316.52 / $1,716.00 / $6,213.00
CDPHP
Facility/Professional
Professional
Modifier
Low / Median / High Price
$316.52 / $316.52 / $490.33
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$378.97 / $378.97 / $378.97
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$192.36 / $370.17 / $802.38
Emblem Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$133.00 / $263.49 / $579.96
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$394.78 / $460.14 / $975.11
Excellus BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$137.81 / $320.14 / $626.16
MVP Health Care
Facility/Professional
Facility
Modifier
Low / Median / High Price
$378.97 / $555.00 / $74,999.25
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$223.82 / $407.94 / $859.71
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
$214.91 / $375.45 / $878.64
Univera
Facility/Professional
Facility
Modifier
Low / Median / High Price
$235.92 / $235.92 / $439.95
Univera
Facility/Professional
Professional
Modifier
Low / Median / High Price
$137.81 / $334.85 / $715.40