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Pennsylvania rates for HCPCS 15760

Graft; composite (eg, full thickness of external ear or nasal ala), including primary closure, donor area

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$696.31 / $2,747.00 / $8,017.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$603.04 / $729.72 / $1,128.55
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,450.00 / $5,951.00 / $8,887.00
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$836.36 / $867.92 / $867.92
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$621.58 / $841.98 / $1,474.17
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,000.41 / $1,286.24 / $1,326.66
Highmark BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,100.23 / $2,100.23 / $2,100.23
Highmark BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$844.07 / $844.07 / $844.07
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$772.48 / $3,077.00 / $8,017.00
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$609.89 / $792.50 / $1,659.00
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$818.20 / $818.20 / $862.80
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,177.51 / $1,177.51 / $1,177.51
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$644.04 / $858.87 / $1,497.79
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$586.51 / $681.00 / $822.96
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$663.20 / $720.75 / $877.01
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$637.00 / $2,391.00 / $6,000.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$679.35 / $881.80 / $1,658.09