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New Hampshire rates for HCPCS Q4113

GRAFTJACKET XPRESS, injectable, 1 cc

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$758.58 / $758.58 / $912.01
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$724.44 / $758.58 / $891.25
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$724.44 / $758.58 / $870.96
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$758.58 / $758.58 / $758.58
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$758.58 / $758.58 / $758.58
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$912.01 / $912.01 / $1,698.24
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$912.01 / $1,995.26 / $1,995.26
Well Sense
Facility/Professional
Facility
Modifier
Low / Median / High Price
$758.58 / $758.58 / $1,230.27