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New Hampshire rates for HCPCS 15110

Epidermal autograft, trunk, arms, legs; first 100 sq cm or less, or 1% of body area of infants and children

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,260.60 / $2,578.48 / $2,969.74
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,449.90 / $1,611.00 / $3,700.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,751.69 / $1,751.69 / $1,812.99
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8,611.00 / $8,611.00 / $8,611.00