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New Hampshire rates for HCPCS 15260

Full thickness graft, free, including direct closure of donor site, nose, ears, eyelids, and/or lips; 20 sq cm or less

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,089.30 / $3,019.95 / $8,128.31
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$741.31 / $954.99 / $2,344.23
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$933.25 / $1,995.26 / $3,388.44
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,584.89 / $1,737.80 / $3,019.95
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$724.44 / $1,318.26 / $1,905.46
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,819.70 / $1,819.70 / $1,819.70
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$912.01 / $1,288.25 / $2,570.40
Harvard Pilgrim
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8,709.64 / $8,709.64 / $8,709.64
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$870.96 / $1,548.82 / $2,630.27
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8,709.64 / $8,709.64 / $8,709.64
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$870.96 / $1,412.54 / $2,818.38
Well Sense
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,047.13 / $1,047.13 / $1,288.25