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New Hampshire rates for HCPCS 15130

Dermal Autograft Trunk/Arm/Leg 1st 100 Cm

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,066.85 / $2,331.21 / $2,350.96
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$428.41 / $579.09 / $733.81
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
$587.09 / $888.83 / $1,356.96
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
$653.15 / $1,093.78 / $1,807.48
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$755.16 / $1,442.79 / $2,391.23
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$9,565.00 / $9,565.00 / $9,565.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$777.34 / $1,066.27 / $2,545.60
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$481.31 / $630.84 / $860.24