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New Hampshire rates for HCPCS Q4116

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$26.44 / $31.73 / $6,664.70
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$25.82 / $26.44 / $37.33
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$31.11 / $31.11 / $31.11
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$31.11 / $31.11 / $31.11
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$31.11 / $31.11 / $31.11
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$31.11 / $31.11 / $45.15
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$31.11 / $31.11 / $31.11