go back

New Hampshire rates for HCPCS Q4141

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$64.75 / $64.75 / $77.70
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$77.70 / $106.97 / $117.66
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$106.97 / $106.97 / $106.97
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.91 / $106.97 / $106.97
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$106.97 / $106.97 / $106.97
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$106.97 / $106.97 / $155.26
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$106.97 / $106.97 / $106.97
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$95.24 / $104.76 / $133.34