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New Hampshire rates for HCPCS 15221

Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; each additional 20 sq cm, or part thereof (List separately in addition to code for primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$263.03 / $2,398.83 / $9,772.37
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$58.88 / $107.15 / $190.55
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$57.54 / $134.90 / $239.88
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$74.13 / $144.54 / $323.59
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
$70.79 / $158.49 / $346.74
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
$77.62 / $165.96 / $338.84
Well Sense
Facility/Professional
Facility
Modifier
Low / Median / High Price
$138.04 / $138.04 / $169.82