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New Hampshire rates for HCPCS 15100

Split-thickness autograft, trunk, arms, legs; first 100 sq cm or less, or 1% of body area of infants and children (except 15050)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,270.40 / $2,511.94 / $3,019.85
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$643.95 / $772.81 / $936.81
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,449.90 / $1,611.00 / $3,700.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$701.27 / $1,067.31 / $1,643.15
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,751.69 / $1,751.69 / $1,812.99
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$777.77 / $1,301.94 / $2,162.88
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$910.78 / $1,740.13 / $2,856.32
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8,611.00 / $8,611.00 / $8,611.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$906.92 / $1,374.79 / $3,043.69
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$614.41 / $755.89 / $1,030.76