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New Hampshire rates for HCPCS 15278

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; each additional 100 sq cm wound surface area, or part thereof, or each additional 1% of body area of infants and children, or part thereof (List separately in addition to code for primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$96.89 / $1,749.77 / $8,965.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$41.78 / $64.19 / $91.66
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$54.02 / $96.88 / $171.26
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$59.60 / $119.98 / $237.73
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$68.40 / $150.33 / $287.69
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
$114.16 / $170.36 / $328.01
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$45.00 / $63.00 / $88.78