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New Hampshire rates for HCPCS Q4125

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$138.91 / $138.91 / $166.70
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$138.91 / $138.91 / $138.91
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$40.21 / $40.75 / $40.75
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,500.00 / $3,000.00 / $3,750.00