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New Hampshire rates for HCPCS 15241

Full thickness graft, free, including direct closure of donor site, forehead, cheeks, chin, mouth, neck, axillae, genitalia, hands, and/or feet; 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
$186.07 / $648.52 / $2,678.80
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$94.93 / $142.21 / $183.31
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$103.19 / $185.04 / $324.06
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$115.24 / $229.41 / $431.84
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$130.66 / $281.64 / $528.42
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7,448.00 / $7,448.00 / $7,448.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$191.82 / $287.73 / $679.68
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$94.02 / $144.31 / $202.03