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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)

Facilitymedian $2,399 · 10th–90th $407–$11,4820%10%20%10th90th$2,399Professionalmedian $178 · 10th–90th $98–$3800%10%10th90th$178$100.0$200.0$500.0$1.0K$2.0K$5.0K$10.0K

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$407.38 / $2,398.83 / $11,481.54
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$93.33 / $158.49 / $295.12
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$89.13 / $186.21 / $323.59
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$114.82 / $204.17 / $426.58
Harvard Pilgrim
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$7,413.10 / $7,413.10 / $7,413.10
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$107.15 / $218.78 / $467.74
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$7,413.10 / $7,413.10 / $7,413.10
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$117.49 / $234.42 / $446.68