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New Hampshire rates for HCPCS 15136

Dermal autograft, face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits; 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)

Facilitymedian $1,820 · 10th–90th $295–$9,7720%10%20%10th90th$1,820Professionalmedian $110 · 10th–90th $76–$2290%10%10th90th$110$100.0$200.0$500.0$1.0K$2.0K$5.0K$10.0K

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$295.12 / $1,819.70 / $9,772.37
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$72.44 / $89.13 / $213.80
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$75.86 / $128.82 / $181.97
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$95.50 / $134.90 / $234.42
Harvard Pilgrim
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$7,413.10 / $7,413.10 / $7,413.10
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$91.20 / $158.49 / $269.15
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$7,413.10 / $7,413.10 / $7,413.10
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$91.20 / $147.91 / $302.00