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New Hampshire rates for HCPCS 15769

Grafting Of Autologous Soft Tiss By Direct Exc

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $2,331.21 / $14,929.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$384.82 / $462.63 / $514.58
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,302.10 / $3,669.21 / $6,000.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$471.94 / $719.36 / $1,186.60
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,257.46 / $5,257.46 / $5,441.47
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$475.17 / $708.28 / $1,230.97
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$540.27 / $1,064.76 / $1,922.23
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$9,949.00 / $9,949.00 / $9,949.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$573.09 / $834.27 / $1,794.60
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$391.26 / $469.51 / $720.04