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New Hampshire rates for HCPCS 15275

Application of skin substitute graft to face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits, total wound surface area up to 100 sq cm; first 25 sq cm or less wound surface area

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $2,331.21 / $6,067.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$83.69 / $114.13 / $217.96
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,449.90 / $1,611.00 / $3,700.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$90.57 / $162.41 / $291.52
Anthem BCBS
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$135.85 / $243.63 / $437.29
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,306.21 / $1,306.21 / $1,351.93
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$103.02 / $203.32 / $394.80
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$118.13 / $254.62 / $494.78
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8,611.00 / $8,611.00 / $8,611.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$188.86 / $264.48 / $552.14
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$81.80 / $128.75 / $186.75