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New Hampshire rates for HCPCS Q4128

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$30.70 / $36.84 / $51,261.09
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$29.91 / $29.91 / $36.84
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$29.91 / $29.91 / $29.91
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$28.22 / $29.91 / $29.91
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$29.91 / $29.91 / $29.91
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$29.91 / $29.91 / $43.41
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$29.91 / $29.91 / $29.91
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,500.00 / $3,000.00 / $3,750.00