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New Hampshire rates for HCPCS 15272

Application of skin substitute graft to trunk, arms, legs, total wound surface area up to 100 sq cm; each additional 25 sq cm wound surface area, or part thereof (List separately in addition to code for primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$29.12 / $1,749.77 / $8,965.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.66 / $20.52 / $25.19
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.17 / $27.44 / $45.66
Anthem BCBS
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$24.25 / $41.16 / $68.48
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$17.92 / $32.97 / $61.13
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20.48 / $42.47 / $74.47
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
$32.89 / $45.96 / $91.29
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.07 / $21.45 / $32.18