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New Hampshire rates for HCPCS 15277

Application of skin substitute graft to face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits, total wound surface area greater than or equal to 100 sq cm; first 100 sq cm wound surface area, or 1% of body area of infants and children

Facilitymedian $2,399 · 10th–90th $1,514–$9,7720%20%10th90th$2,399Professionalmedian $355 · 10th–90th $204–$7590%5%10%10th90th$355$100.0$200.0$500.0$1.0K$2.0K$5.0K$10.0K

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$660.69 / $2,398.83 / $9,772.37
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$194.98 / $275.42 / $602.56
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,513.56 / $1,737.80 / $3,890.45
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$199.53 / $380.19 / $630.96
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,348.96 / $1,348.96 / $1,348.96
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$234.42 / $389.05 / $812.83
Harvard Pilgrim
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$8,709.64 / $8,709.64 / $8,709.64
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$239.88 / $467.74 / $954.99
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$8,709.64 / $8,709.64 / $8,709.64
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$251.19 / $467.74 / $954.99