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New Hampshire rates for HCPCS 15115

Epidermal Agrft F/S/N/H/F/G/M/D Gt 1st 100 Cm/<

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,238.47 / $2,678.45 / $3,010.67
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$536.63 / $681.67 / $940.50
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
$684.78 / $1,018.90 / $1,538.88
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
$764.01 / $1,193.97 / $2,061.06
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$867.12 / $1,657.15 / $2,789.14
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
$830.42 / $1,295.71 / $2,768.45
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$589.79 / $729.07 / $941.22