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New Hampshire rates for HCPCS 15150

Tissue cultured skin autograft, trunk, arms, legs; first 25 sq cm or less

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,128.61 / $2,331.21 / $2,443.19
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$465.73 / $615.73 / $745.94
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
$626.54 / $906.46 / $1,335.37
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
$671.01 / $1,081.30 / $1,804.07
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$787.26 / $1,503.59 / $2,429.88
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
$809.08 / $967.69 / $2,446.38
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$501.12 / $585.30 / $701.57