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New Hampshire rates for HCPCS Q4165

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

Facilitymedian $54 · 10th–90th $46–$2510%20%10th90th$54Professionalmedian $46 · 10th–90th $44–$1260%50%10th90th$46$10.0$50.0$200.0$1.0K

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$45.71 / $53.70 / $131.83
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$41.69 / $44.67 / $53.70
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$125.89 / $125.89 / $125.89
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$144.54 / $251.19 / $338.84
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$125.89 / $125.89 / $125.89
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$45.71 / $45.71 / $85.11
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$45.71 / $125.89 / $125.89
Well Sense
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$117.49 / $144.54 / $162.18