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New Hampshire rates for HCPCS Q4111

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7.12 / $7.12 / $8.53
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.87 / $7.87 / $8.66
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.87 / $7.87 / $7.87
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7.43 / $7.87 / $7.87
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.87 / $7.87 / $7.87
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.87 / $7.87 / $11.42
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.87 / $7.87 / $7.87