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New Hampshire rates for HCPCS 15261

Full thickness graft, free, including direct closure of donor site, nose, ears, eyelids, and/or lips; 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
$235.58 / $757.39 / $2,341.64
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$104.65 / $164.61 / $237.08
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$130.36 / $226.23 / $382.25
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$150.38 / $300.29 / $512.85
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$165.07 / $343.77 / $623.32
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
$235.50 / $342.94 / $740.61
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$118.75 / $173.79 / $233.49