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New Hampshire rates for HCPCS Q4137

AmnioExcel, AmnioExcel Plus or BioDExcel, per sq cm (add-on, list separately in addition to primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.72 / $100.72 / $120.86
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$101.72 / $101.72 / $120.86
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$101.72 / $101.72 / $101.72
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$95.96 / $101.72 / $101.72
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$101.72 / $101.72 / $101.72
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$101.72 / $101.72 / $147.63
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$101.72 / $101.72 / $249.49
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$169.83 / $186.81 / $237.76