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New Hampshire rates for HCPCS 15770

Graft; derma-fat-fascia

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,290.87 / $2,398.83 / $11,481.54
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$501.19 / $616.60 / $851.14
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,467.37 / $4,677.35 / $6,309.57
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$602.56 / $1,174.90 / $1,737.80
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,089.30 / $2,089.30 / $2,089.30
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$691.83 / $977.24 / $1,778.28
Harvard Pilgrim
Facility/Professional
Facility
Modifier
Low / Median / High Price
$10,000.00 / $10,000.00 / $10,000.00
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$707.95 / $1,202.26 / $1,905.46
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$10,000.00 / $10,000.00 / $10,000.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$660.69 / $1,071.52 / $2,290.87
Well Sense
Facility/Professional
Facility
Modifier
Low / Median / High Price
$691.83 / $691.83 / $851.14