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New Hampshire rates for HCPCS Q4101

Apligraf Per Square Centimeter

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$30.30 / $30.30 / $36.36
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.23 / $30.23 / $36.28
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.23 / $30.23 / $30.23
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$28.52 / $30.23 / $30.23
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.23 / $30.23 / $30.23
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.23 / $30.23 / $43.88
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.23 / $30.23 / $45.99
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$36.54 / $43.85 / $64.45