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New Hampshire rates for HCPCS 15240

Full thickness graft, free, including direct closure of donor site, forehead, cheeks, chin, mouth, neck, axillae, genitalia, hands, and/or feet; 20 sq cm or less

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,418.53 / $2,802.01 / $9,859.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$691.22 / $799.87 / $1,020.58
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,028.41 / $3,028.41 / $3,028.41
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
$779.23 / $1,163.69 / $1,763.11
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,000.36 / $2,000.36 / $2,070.38
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$861.60 / $1,391.10 / $2,410.19
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$986.73 / $1,885.70 / $3,173.82
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
$790.84 / $1,318.11 / $3,271.05
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$666.09 / $811.06 / $1,106.00