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New Hampshire rates for HCPCS Q4101

Apligraf, per sq cm (add-on, list separately in addition to primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$30.20 / $36.31 / $131.83
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.20 / $30.20 / $87.10
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$45.71 / $46.77 / $52.48
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$28.84 / $30.20 / $30.20
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.20 / $30.20 / $30.20
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.20 / $30.20 / $56.23
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.20 / $45.71 / $125.89
Well Sense
Facility/Professional
Facility
Modifier
Low / Median / High Price
$46.77 / $46.77 / $74.13