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New Hampshire rates for HCPCS Q4151

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$131.83 / $134.90 / $162.18
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$134.90 / $134.90 / $165.96
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$125.89 / $125.89 / $125.89
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$125.89 / $134.90 / $134.90
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$134.90 / $134.90 / $134.90
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$134.90 / $134.90 / $218.78
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$125.89 / $134.90 / $134.90