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New Hampshire rates for HCPCS 15131

Dermal autograft, trunk, arms, legs; each additional 100 sq cm, or each additional 1% of body area of infants and children, or part thereof (List separately in addition to code for primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$156.76 / $349.48 / $2,331.21
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$59.46 / $87.50 / $109.40
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$87.01 / $125.83 / $184.55
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$94.15 / $151.81 / $245.80
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$109.24 / $206.59 / $328.13
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7,448.00 / $7,448.00 / $7,448.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$120.83 / $136.12 / $343.08
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$71.91 / $83.99 / $100.67