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New Hampshire rates for HCPCS 15276

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; 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
$43.09 / $1,749.77 / $8,965.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.10 / $25.72 / $32.10
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$23.94 / $38.38 / $61.31
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$26.45 / $46.16 / $80.09
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.31 / $60.69 / $99.97
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
$44.54 / $54.44 / $118.13
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$22.17 / $29.35 / $39.38