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New Hampshire rates for HCPCS Q4175

MiroDerm Bio Matrix Fenestrat EX SHEE 2X2CM

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$67.72 / $67.72 / $81.26
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$81.26 / $91.54 / $100.69
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$91.54 / $91.54 / $91.54
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$86.36 / $91.54 / $91.54
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$91.54 / $91.54 / $91.54
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$91.54 / $91.54 / $132.86
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$91.54 / $91.54 / $180.09
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$65.88 / $72.47 / $92.23