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New Hampshire rates for HCPCS Q4132

Grafix Core and GrafixPL Core, per sq cm (add-on, list separately in addition to primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$89.18 / $89.18 / $107.02
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$106.70 / $106.70 / $117.37
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$106.70 / $106.70 / $106.70
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.66 / $106.70 / $106.70
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$106.70 / $106.70 / $106.70
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$106.70 / $106.70 / $154.86
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$106.70 / $106.70 / $256.08
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$299.20 / $329.12 / $418.88