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New Hampshire rates for HCPCS Q4178

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$93.11 / $93.11 / $111.73
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$89.41 / $89.41 / $107.29
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$89.41 / $89.41 / $89.41
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$84.35 / $89.41 / $89.41
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$89.41 / $89.41 / $89.41
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$89.41 / $89.41 / $129.77
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$89.41 / $89.41 / $191.34
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$191.25 / $210.38 / $267.75