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New Hampshire rates for HCPCS 15135

Dermal Autograft F/S/N/H/F/G/M/D Gt 1st 100

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,343.95 / $2,700.04 / $3,020.40
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$552.95 / $736.96 / $946.95
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,302.10 / $3,669.21 / $6,000.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$740.41 / $1,096.08 / $1,648.17
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
$815.29 / $1,303.38 / $2,283.69
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$937.57 / $1,791.78 / $2,999.06
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$9,949.00 / $9,949.00 / $9,949.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$971.67 / $1,472.74 / $3,054.95
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$616.66 / $794.22 / $1,128.54