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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

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
$196.53 / $244.02 / $340.88
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
$215.75 / $376.37 / $638.12
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
$239.33 / $450.40 / $859.71
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$281.42 / $584.08 / $1,060.27
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
$385.30 / $577.01 / $1,306.06
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$178.31 / $249.63 / $324.92