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New Hampshire rates for HCPCS Q4188

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$487.59 / $487.59 / $585.11
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$487.59 / $487.59 / $585.10
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$487.59 / $487.59 / $487.59
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$459.99 / $487.59 / $487.59
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$487.59 / $487.59 / $487.59
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$487.59 / $487.59 / $707.69
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$487.59 / $487.59 / $832.73
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$489.60 / $538.55 / $685.44