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New Hampshire rates for HCPCS 15151

Tissue cultured skin autograft, trunk, arms, legs; additional 1 sq cm to 75 sq cm (List separately in addition to code for primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$416.87 / $1,819.70 / $9,772.37
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$85.11 / $107.15 / $151.36
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$97.72 / $158.49 / $223.87
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$107.15 / $154.88 / $302.00
Harvard Pilgrim
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7,413.10 / $7,413.10 / $7,413.10
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$117.49 / $204.17 / $331.13
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7,413.10 / $7,413.10 / $7,413.10
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$120.23 / $181.97 / $354.81
Well Sense
Facility/Professional
Facility
Modifier
Low / Median / High Price
$117.49 / $117.49 / $144.54