Price of Skin Split Graft for Trunk, Arm, or Leg at NYU Langone
Last Updated: 2024-07-01
Locations
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NYU Langone|Tisch Hospital
550 1st Ave., New York, NY 10016About Skin Split Graft for Trunk, Arm, or Leg
Service Codes: CPT 15100, LOCAL 2020111
This procedure involves taking a thin layer of skin from one area of the body and transplanting it to another area on the trunk, arm, or leg. It is used to cover wounds, burns, or areas of skin loss to promote healing and restore skin integrity.
Pricing Overview
Cash Price
$1,176.54
Median Price
$4,829.99
Price Range
$908.68 - $13,547.57
Insurance Plan Prices
| Insurance Provider | Plan Type | Price |
|---|---|---|
| Aetna | Wellnet ASA PPO | $8,124.66 |
| MetroPlus | Essential Plan 4 | $1,678.52 |
| Fidelis Care | Wellcare Medicare Advantage | $2,114.18 |
| Blue Cross Blue Shield | HMO | $9,619.00 |
| EmblemHealth | HIP VIP Medicare Montefiore | $2,114.18 |
| UnitedHealthcare - Oxford | Freedom | $5,318.00 |
| Anthem BCBS HealthPlus | Essential Plan 1, 200-250 | $3,357.04 |
| Blue Cross Blue Shield | Blue Connection | $9,619.00 |
| EmblemHealth | HIP Access II | $7,558.00 |
| EmblemHealth | Select Care Gold Exchange | $9,585.45 |
| EmblemHealth | Essential Plan 4 | $1,678.52 |
| HealthSmart | WTC Health Program - NYCHHC | $2,114.18 |
| MetroPlus | SilverPlus | $4,186.07 |
| MultiPlan | Kaiser Permanente | $4,829.99 |
| MagnaCare | National Health Plan | $13,547.57 |
| Blue Cross Blue Shield | Healthy New York | $9,619.00 |
| Fidelis Care | Bronze (Exchange) | $3,021.33 |
| Blue Cross Blue Shield | Blue Access gEPO (Large Group) | $8,657.00 |
| CenterLight | PACE Medicare HMO | $2,156.46 |
| Anthem BCBS HealthPlus | Child Health Plus (CHP) | $1,678.52 |
| Healthfirst | Essential Plan 3-4 | $908.68 |
| UnitedHealthcare | POS | $6,762.00 |
| Fidelis Care | Platinum (Exchange) | $3,021.33 |
| 1199SEIU Funds | Member Choice Home Care Select | $5,493.00 |
| EmblemHealth | HIP PPO | $7,558.00 |
| MultiPlan | Humana Health Plan | $4,829.99 |
| MultiPlan | QualCare Inc | $4,829.99 |
| Blue Cross Blue Shield | EPO | $9,619.00 |
| EmblemHealth | Healthcare Partners Essential Plan 1-2 | $2,014.22 |
| Veterans Choice | Veterans Choice Program | $2,114.18 |
| MultiPlan | Paramount Insurance | $4,829.99 |
| MetroPlus | Essential Plan 3 | $1,678.52 |
| BCBS (Out of State) | Indemnity | $9,619.00 |
| Humana | All Commercial Plans | $4,829.99 |
| MetroPlus | Essential Plan 1-2, 200-250 | $1,678.52 |
| Fidelis Care | Essential Plan 1 | $3,608.81 |
| Fidelis Care | Medicaid Managed Care | $2,081.36 |
| EmblemHealth | VIP Prime HMO Medicare Advantage | $2,114.18 |
| Amida Care | Medicaid Managed Care | $1,678.52 |
| EmblemHealth | HIP | $7,558.00 |
| HealthSmart | WTC Health Program - UMDNJ Rutgers | $2,114.18 |
| Anthem BCBS HealthPlus | SOMOS ny medicaid | $1,762.44 |
| Anthem BCBS HealthPlus | Family Health Plus (Deprecated) | $1,678.52 |
| EmblemHealth | American Plan Administrators | $11,277.00 |
| Partners Health Plan | Medicare Advantage | $2,114.18 |
| Cigna | MVP-Cigna Network | $5,418.00 |
| MetroPlus | Medicare Advantage | $2,114.18 |
| Fidelis Care | Essential Plan 4 | $2,081.36 |
| Blue Cross Blue Shield | UniCare | $9,619.00 |
| Blue Cross Blue Shield | Blue Access EPO (Large Group) (NY LI Local 1199SEIU) | $8,657.00 |
| Elderplan | All Plans | $2,114.18 |
| MultiPlan | PHCS Director Guild | $4,829.99 |
| BCBS (Out of State) | Medicare (Suitcase Logo) | $2,114.18 |
| VillageCareMAX | All Plans | $2,114.18 |
| BCBS (Out of State) | POS (Suitcase Logo) | $9,619.00 |
| BCBS (Out of State) | HMO (No Suitcase Logo) | $9,619.00 |
| MultiPlan | Fiserv Health | $4,829.99 |
| MultiPlan | Nippon Life | $4,829.99 |
| EmblemHealth | Essential Plan 3 | $1,678.52 |
| EmblemHealth | HIP Optum Health | $7,558.00 |
| UnitedHealthcare | Navigate | $6,762.00 |
| EmblemHealth | HIP Montefiore | $7,558.00 |
| HealthSmart | WTC Health Program - NYU | $2,114.18 |
| MultiPlan | Administrative Concepts | $4,829.99 |
| UnitedHealthcare | Charter | $6,762.00 |
| Healthfirst | Senior Health Partners (MLTC) | $908.68 |
| Partners Health Plan | Medicare Advantage (Home-based Only) | $2,114.18 |
| Blue Cross Blue Shield | Blue Priority EPO (Small Group) | $7,695.00 |
| Anthem BCBS HealthPlus | Special Needs Plan (SNP) | $1,678.52 |
| Anthem BCBS HealthPlus | SOMOS Essential Plan 3 | $1,762.44 |
| Blue Cross Blue Shield | Pathway X Enhanced | $2,014.22 |
| HealthSmart | WTC Health Program - Logistic Health Inc | $2,114.18 |
| MultiPlan | Capital District Physicians Health Plan | $4,829.99 |
| Blue Cross Blue Shield | POS | $9,619.00 |
| BCBS (Out of State) | Medicare (No Suitcase Logo) | $2,114.18 |
| Blue Cross Blue Shield | Global Transplants | $9,619.00 |
| MetroPlus | MedPlus | $4,186.07 |
| Fidelis Care | Essential Plan 3 | $2,081.36 |
| Sedgwick | WTC Health Program - Northwell | $2,114.18 |
| Blue Cross Blue Shield | PPO | $9,619.00 |
| VNS Health | SelectHealth (Medicaid) | $1,678.52 |
| BCBS (Out of State) | PPO (No Suitcase Logo) | $9,619.00 |
| BCBS (Out of State) | Medicare | $2,114.18 |
| Aetna | Indemnity | $5,015.76 |
| Blue Cross Blue Shield | Blue Priority PPO | $9,619.00 |
| EmblemHealth | GHI Medicare PPO | $2,114.18 |
| Cigna | NALC PPO | $5,418.00 |
| UnitedHealthcare - Oxford | Optum Health | $5,318.00 |
| Aetna | Open Access HMO | $8,124.66 |
| Fidelis Care | Bronze for Children (Exchange) | $3,021.33 |
| EmblemHealth | CMO Essential Plan 4 | $1,678.52 |
| Three Rivers | All Plans (Home-based Only) | $5,573.07 |
| UnitedHealthcare - Oxford | Liberty | $5,318.00 |
| UnitedHealthcare | HMO | $6,762.00 |
| Cigna | Great West HMO | $5,418.00 |
| Cigna | Wellfleet Student | $5,418.00 |
| EmblemHealth | HIP compre health epo | $7,558.00 |
| CenterLight | Select | $2,156.46 |
| MetroPlus | Child Health Plus (CHP) | $1,678.52 |
| Aetna | HMO | $8,124.66 |
| UnitedHealthcare | POMCO (UMR) | $4,829.99 |
| MagnaCare | Independent Care Plus | $13,547.57 |
| Fidelis Care | Gold (Exchange) | $3,021.33 |
| EmblemHealth | Enhanced Care (Medicaid) Montefiore | $1,678.52 |
| Cigna | Great West PPO | $5,418.00 |
| MagnaCare | Capital District Physicians Health Plan | $13,547.57 |
| GEHA | All Plans | $8,124.66 |
| EmblemHealth | HIP POS | $7,558.00 |
| 1199SEIU Funds | Home Care Benefit Fund | $5,493.00 |
| Carelon Behavioral Health | Medicaid Managed Care (Home-based Only) | $1,678.52 |
| Blue Cross Blue Shield | Open Access HMO (Home-based Only) | $9,619.00 |
| EmblemHealth | Healthcare Partners Essential Plan 3 | $1,678.52 |
| EmblemHealth | HIP Long Island College Hospital (LICH) | $7,558.00 |
| Anthem BCBS | Empire Plan, Value Options | $9,619.00 |
| Blue Cross Blue Shield | MediBlue (Medicare Advantage) Select HMO/Extra HMO | $2,114.18 |
| CenterLight | PACE | $2,156.46 |
| MultiPlan | PHCS | $4,829.99 |
| EmblemHealth | HIP Healthcare Partners HMO | $7,558.00 |
| MagnaCare | Cement & Concrete Workers District Council | $13,547.57 |
| MultiPlan | Principal Financial Group | $4,829.99 |
| AgeWell (Deprecated) | Medicaid Managed Care | $1,678.52 |
| Anthem BCBS HealthPlus | Medicaid | $1,678.52 |
| Fidelis Care | Silver for Children (Exchange) | $3,021.33 |
| Aetna | Allied ASA PPO | $8,124.66 |
| Healthfirst | Personal Wellness Plan (HARP) | $1,678.52 |
| Fidelis Care | Platinum for Children (Exchange) | $3,021.33 |
| VNS Health | Total (Medicare + Medicaid) | $2,114.18 |
| EmblemHealth | Healthcare Partners Essential Plan 1, 200-250 | $2,014.22 |
| UnitedHealthcare | WTC Health Program | $2,114.18 |
| Blue Cross Blue Shield | Indemnity | $9,619.00 |
| EmblemHealth | Select Care Catastrophic Exchangeu00a0 | $9,585.45 |
| Blue Cross Blue Shield | PPO/EPO (Small Group) | $7,695.00 |
| EmblemHealth | American Plan Administrators c/o H.D.A | $11,277.00 |
| EmblemHealth | Prime Silver | $9,585.45 |
| Aetna | Signature Administrators PPO | $8,124.66 |
| Anthem BCBS | All Plans | $9,619.00 |
| EmblemHealth | Select Care Silver Exchange | $9,585.45 |
| Fidelis Care | Child Health Plus (CHP) | $2,081.36 |
| EmblemHealth | CMO Essential Plan 2 | $2,014.22 |
| Aetna | Student Health | $8,124.66 |
| UnitedHealthcare | Independent | $6,762.00 |
| EmblemHealth | Enhanced Care (Medicaid) (SOMOS) | $1,762.44 |
| Cigna | Tufts Health Plan | $5,418.00 |
| UnitedHealthcare | PPO | $6,762.00 |
| EmblemHealth | Healthcare Partners Essential Plans | $2,014.22 |
| Senior Whole Health | All Plans | $2,114.18 |
| EmblemHealth | Healthcare Partners Essential Plan 3-4 | $1,678.52 |
| AgeWell (Deprecated) | Medicare Advantage | $2,114.18 |
| EmblemHealth | Enhanced Care (Medicaid) | $1,678.52 |
| HealthSmart | WTC Health Program - Northwell | $2,114.18 |
| UnitedHealthcare | Medicare Advantage Complete Choice Regional PPO | $2,114.18 |
| MagnaCare | JIB Employees Security Fund | $13,547.57 |
| Anthem BCBS HealthPlus | SOMOS Essential Plan 2 | $2,266.00 |
| MetroPlus | Essential Plan 2 | $1,678.52 |
| UnitedHealthcare | Golden Rule Insurance | $6,762.00 |
| Maksin Group | Consolidated Health Plan (Home-based only) | $5,418.00 |
| Partners Health Plan | Medicaid MLTC | $1,678.52 |
| BCBS (Out of State) | HMO (Suitcase Logo) | $9,619.00 |
| EmblemHealth | Enhanced Care (Medicaid) SNP HARP (SOMOS) | $1,762.44 |
| MultiPlan | AXA Global Insurance | $4,829.99 |
| Cigna | PPO | $5,418.00 |
| Aetna | POS | $8,124.66 |
| Blue Cross Blue Shield | Pathway | $2,014.22 |
| CenterLight | Direct | $2,156.46 |
| Blue Cross Blue Shield | Blue Access HMO (Small Group) | $7,695.00 |
| Aetna | Chesterfield Resources ASA PPO | $8,124.66 |
| EmblemHealth | Select Care Bronze Exchange | $9,585.45 |
| HealthSmart | WTC Health Program - Mt. Sinai | $2,114.18 |
| Blue Cross Blue Shield | Blue Access gEPO (Small Group) | $7,695.00 |
| Blue Cross Blue Shield | Blue Priority HMO | $9,619.00 |
| Blue Cross Blue Shield | Open Access PPO (Home-based Only) | $9,619.00 |
| UnitedHealthcare | Core | $6,762.00 |
| Healthfirst | Essential Plan 4 | $908.68 |
| EmblemHealth | Enhanced Care (Medicaid) Essential Plan 3 (SOMOS) | $1,762.44 |
| EmblemHealth | GHI Medicare Supplement | $2,114.18 |
| Fidelis Care | Native American (Exchange) | $3,021.33 |
| Cigna | Open Access | $5,418.00 |
| EmblemHealth | Select Care Silver Small Group | $9,585.45 |
| Blue Cross Blue Shield | MediBlue (Medicare Advantage) Select/Extra HMO (HCP) | $2,114.18 |
| Fidelis Care | Silver 250 (Exchange) | $3,021.33 |
| MagnaCare | Direct Plus | $13,547.57 |
| EmblemHealth | Prime Bronze | $9,585.45 |
| Healthfirst | Personal Wellness Plan (HARP) | $908.68 |
| EmblemHealth | Select Care Healthcare Partners | $9,585.45 |
| Aetna | Open Access Elect Choice EPO | $8,124.66 |
| MetroPlus | Essential Plan 3-4 | $1,678.52 |
| Healthfirst | Medicaid Managed Care | $908.68 |
| Horizon BCBS | Direct | $9,619.00 |
| Hamaspik | Medicare Advantage | $4,228.36 |
| EmblemHealth | HIP VIP Medicare Bold | $2,114.18 |
| EmblemHealth | GHI HMO | $11,277.00 |
| MultiPlan | Diversified Admin Corp | $4,829.99 |
| Anthem BCBS HealthPlus | Essential Plan 2 | $3,357.04 |
| EmblemHealth | Select Care Platinum Small Group | $9,585.45 |
| Anthem BCBS HealthPlus | All Exchange Plans | $2,014.22 |
| Aetna | Nippon Life ASA PPO | $8,124.66 |
| MultiPlan | Teamsters Allied Benefits | $4,829.99 |
| UnitedHealthcare | Medicare Advantage | $2,114.18 |
| MultiPlan | Screen Actors Guild | $4,829.99 |
| Fidelis Care | Essential Plan 2 | $3,608.81 |
| UnitedHealthcare | AARP Medicare Advantage Complete Mosaic | $2,114.18 |
| Carelon Behavioral Health | All Exchange Plans (Home-based Only) | $2,114.18 |
| Cigna | Premier Plus | $5,418.00 |
| EmblemHealth | Healthcare Partners Essential Plan 4 | $1,678.52 |
| Aetna | Christian Brothers ASA PPO | $8,124.66 |
| EmblemHealth | Select Care Basic Exchange | $9,585.45 |
| Cigna | Indemnity | $5,418.00 |
| Partners Health Plan | Medicaid | $1,678.52 |
| EmblemHealth | Enhanced Care (Medicaid) Essential Plan 4 (SOMOS) | $1,762.44 |
| First Health | PPO | $4,829.99 |
| Cigna | LifeSOURCE | $5,418.00 |
| Carelon Behavioral Health | Medicare Advantage (Home-based Only) | $2,114.18 |
| EmblemHealth | Vytra HMO | $7,558.00 |
| MultiPlan | Global Excel Management | $4,829.99 |
| Anthem BCBS HealthPlus | SOMOS Special Needs HARP | $1,762.44 |
| Cigna | Cigna Managed Care/POS | $5,418.00 |
| MetroPlus | GoldCare 2 | $1,678.52 |
| Anthem BCBS HealthPlus | SOMOS Essential Plan 4 | $1,762.44 |
| MultiPlan | Healthnet of California | $4,829.99 |
| Healthfirst | Essential Plan 3 | $908.68 |
| Fidelis Care | Silver (Exchange) | $3,021.33 |
| EmblemHealth | HIP Medicare Supplement | $2,114.18 |
| EmblemHealth | Enhanced Care (Medicaid) Essential Plan 2 (SOMOS) | $2,266.00 |
| UnitedHealthcare | AARP Medicare Advantage Complete | $2,114.18 |
| Riverspring Health Plans | Medicare Advantage | $2,114.18 |
| Cigna | Evernorth Behavioral Health | $5,418.00 |
| Fidelis Care | Catastrophic (Exchange) | $3,021.33 |
| Partners Health Plan | FIDA | $2,114.18 |
| MetroPlus | Gold | $1,678.52 |
| Aetna | Starmark ASA PPO | $8,124.66 |
| EmblemHealth | HIP VIP Medicare Healthcare Partners | $2,114.18 |
| Anthem BCBS HealthPlus | SOMOS Essential Plan 1 & 200-250 | $2,266.00 |
| BCBS (Out of State) | PPO (Suitcase Logo) | $9,619.00 |
| First Health | Commercial HMO | $5,201.53 |
| EmblemHealth | GHI EPO | $11,277.00 |
| MultiPlan | Mutual of Omaha | $4,829.99 |
| EmblemHealth | Select Care HMO | $9,585.45 |
| HealthSmart | WTC Health Program - Stony Brook | $2,114.18 |
| EmblemHealth | GHI Medicare HMO | $2,114.18 |
| EmblemHealth | Select Care PPOu00a0 | $9,585.45 |
| MagnaCare | JIB Members | $13,547.57 |
| UnitedHealthcare - Oxford | Medicare Advantage | $2,114.18 |
| UnitedHealthcare | Choice (North Shore - LIJ) | $6,762.00 |
| Blue Cross Blue Shield | Senior Care Supplemental | $2,114.18 |
| EmblemHealth | Select Care EPO | $9,585.45 |
| EmblemHealth | Enhanced Care (Medicaid) Essential Plan 1, 200-250 (SOMOS) | $2,266.00 |
| EmblemHealth | HIP VIP Medicare Affinity | $2,114.18 |
| VNS Health | EasyCare (Medicare Advantage) | $2,114.18 |
| Elderplan | FIDA | $2,114.18 |
| EmblemHealth | GHI Comprehensive Benefits Plan (CBP) | $11,277.00 |
| EmblemHealth | HIP Prime Basic | $9,585.45 |
| Anthem BCBS HealthPlus | Essential Plan 4 | $1,678.52 |
| Blue Cross Blue Shield | Child Health Plus (CHP) | $1,678.52 |
| Blue Cross Blue Shield | Blue Access EPO (Small Group) | $7,695.00 |
| EmblemHealth | Prime Platinum | $9,585.45 |
| BCBS (Out of State) | HMO | $9,619.00 |
| BCBS (Out of State) | EPO (Suitcase Logo) | $9,619.00 |
| EmblemHealth | Essential Plan 1, 200-250 | $2,014.22 |
| Centers Plan for Healthy Living | All Plans | $2,114.18 |
| EmblemHealth | Enhanced Care (Medicaid) Healthcare Partners | $1,678.52 |
| MultiPlan | PPO | $4,829.99 |
| EmblemHealth | GHI PPO | $11,277.00 |
| EmblemHealth | CMO Essential Plan 1 | $2,014.22 |
| EmblemHealth | Bridge | $7,558.00 |
| EmblemHealth | HIP VIP Medicare Reserve | $2,114.18 |
| MagnaCare | Direct Plus Preferred | $13,547.57 |
| Aetna | PPO | $8,124.66 |
| EmblemHealth | GHI composite | $11,277.00 |
| Better Health Plan | All Plans | $5,201.53 |
| VNS Health | EasyCare Plus (Medicare+Medicaid) | $2,114.18 |
| UnitedHealthcare - Oxford | Metro | $5,318.00 |
| MultiPlan | US Life Insurance Co | $4,829.99 |
| Healthfirst | Child Health Plus (CHP) | $908.68 |
| EmblemHealth | IUOE Local 14-14B | $11,277.00 |
| Aetna | Healthscope ASA PPO | $8,124.66 |
| Blue Cross Blue Shield | Hotel Trades Council | $9,619.00 |
| Cigna | Open Access PPO | $5,418.00 |
| BCBS (Out of State) | EPO | $9,619.00 |
| MetroPlus | BronzePlus | $4,186.07 |
| MultiPlan | Meritain Health | $4,829.99 |
| EmblemHealth | BCBS GHI Composite | $9,619.00 |
| Anthem BCBS HealthPlus | SOMOS Child Health Plus (CHP) | $1,762.44 |
| EmblemHealth | HIP Child Health Plus | $1,678.52 |
| Aetna | Meritain Health | $8,124.66 |
| UnitedHealthcare | Choice | $6,762.00 |
| MagnaCare | PPO | $13,547.57 |
| Cigna | Open Access HMO | $5,418.00 |
| MagnaCare | American Plan Administrators | $13,547.57 |
| MultiPlan | Guardian Life Insurance Co | $4,829.99 |
| Aetna | Medicare Advantage | $2,114.18 |
| EmblemHealth | HIP SmartStart | $7,558.00 |
| Blue Cross Blue Shield | Federal Program | $9,619.00 |
| EmblemHealth | Enhanced Care (Medicaid) Child Health Plus (SOMOS) | $1,762.44 |
| MetroPlus | PlatinumPlus | $4,186.07 |
| MetroPlus | GoldPlus | $4,186.07 |
| Champus | Unysis Corp | $2,114.18 |
| BCBS (Out of State) | POS (No Suitcase Logo) | $9,619.00 |
| Blue Cross Blue Shield | MediBlue (Medicare Advantage) HMO (HCP) | $2,114.18 |
| Blue Cross Blue Shield | MediBlue (Medicare Advantage) HMO | $2,114.18 |
| EmblemHealth | Essential Plan 2 | $2,014.22 |
| Aetna | Global National Transplant | $8,124.66 |
| EmblemHealth | HIP Access I | $7,558.00 |
| MultiPlan | PHCS Savility | $4,829.99 |
| UnitedHealthcare | Optum Health | $6,762.00 |
| Blue Cross Blue Shield | MediBlue (Medicare Advantage) PPO | $2,114.18 |
| MultiPlan | Global Health Management | $4,829.99 |
| UnitedHealthcare | Student Resources | $6,762.00 |
| Blue Cross Blue Shield | Pathway Enhanced | $2,014.22 |
| 1199SEIU Funds | PPO | $5,493.00 |
| EmblemHealth | Select Care Bronze Small Group | $9,585.45 |
| EmblemHealth | Healthcare Partners Essential Plan 2 | $2,014.22 |
| UnitedHealthcare | AARP Medicare Advantage Complete Essentials | $2,114.18 |
| UnitedHealthcare | Choice (NY Power Authority) | $6,762.00 |
| MultiPlan | PHP Healthcare (Champus) | $4,829.99 |
| Blue Cross Blue Shield | Blue Access PPO (Large Group) | $8,657.00 |
| Blue Cross Blue Shield | Blue Access EPO (Large Group) | $8,657.00 |
| UnitedHealthcare | AARP | $2,114.18 |
| Cigna | HMO | $5,418.00 |
| Anthem BCBS HealthPlus | Medicare Advantage | $2,114.18 |
| Fidelis Care | Gold for Children (Exchange) | $3,021.33 |
| EmblemHealth | HIP EPO | $7,558.00 |
| EmblemHealth | GHI Behavioral Management Program | $11,277.00 |
| Aetna | Coresource ASA PPO | $8,124.66 |
| EmblemHealth | HIP HMO | $7,558.00 |
| BCBS (Out of State) | POS | $9,619.00 |
| UnitedHealthcare | POMCO (UMR) | $6,762.00 |
| Blue Cross Blue Shield | Local 32 BJ | $9,619.00 |
| Anthem BCBS | Optum | $9,619.00 |
| EmblemHealth | HIP compre health | $7,558.00 |
| Anthem BCBS HealthPlus | Essential Plan 3 | $1,678.52 |
| EmblemHealth | WLNY-TV | $11,277.00 |
| BCBS (Out of State) | PPO | $9,619.00 |
| MetroPlus | Essential Plan 1 | $1,678.52 |
| VNS Health | MLTC (Medicaid) | $1,678.52 |
| EmblemHealth | CMO Essential Plan 3 | $1,678.52 |
| Health Net | PPO | $4,829.99 |
| EmblemHealth | Prime Gold | $9,585.45 |
| VA Community Care Network | Optum | $2,114.18 |
| EmblemHealth | Select Care Gold Small Group | $9,585.45 |
| MetroPlus | Medicaid Managed Care | $1,678.52 |
| EmblemHealth | Select Care Platinum Exchange | $9,585.45 |
| UnitedHealthcare | EPO | $6,762.00 |
| HealthSmart | WTC Health Program - FDNY | $2,114.18 |
| BCBS (Out of State) | EPO (No Suitcase Logo) | $9,619.00 |