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New Hampshire rates for HCPCS 15115

Epidermal autograft, face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits; 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
$2,398.83 / $2,691.53 / $9,772.37
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$602.56 / $691.83 / $1,000.00
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,584.89 / $1,737.80 / $3,019.95
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$645.65 / $1,071.52 / $1,548.82
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,819.70 / $1,819.70 / $1,819.70
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$724.44 / $1,071.52 / $2,089.30
Harvard Pilgrim
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8,709.64 / $8,709.64 / $8,709.64
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$794.33 / $1,348.96 / $2,290.87
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8,709.64 / $8,709.64 / $8,709.64
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$794.33 / $1,174.90 / $2,344.23
Well Sense
Facility/Professional
Facility
Modifier
Low / Median / High Price
$831.76 / $831.76 / $1,023.29