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New Hampshire rates for HCPCS 15760

Graft Composite W/Primary Closure Donor Area

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,241.11 / $2,500.28 / $2,963.90
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$536.58 / $678.54 / $935.53
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
$683.16 / $1,040.98 / $1,604.20
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,751.69 / $1,751.69 / $1,812.99
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$759.85 / $1,263.04 / $2,109.01
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$889.20 / $1,698.90 / $2,782.53
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
$945.75 / $1,419.54 / $3,201.18
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$607.11 / $736.55 / $1,004.39