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New Hampshire rates for HCPCS Q4203

Derma-gide, 1 sq cm

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$871.37 / $871.37 / $1,045.64
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,045.64 / $1,052.89 / $1,158.18
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,052.89 / $1,052.89 / $1,052.89
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$993.29 / $1,052.89 / $1,052.89
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,052.89 / $1,052.89 / $1,052.89
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,052.89 / $1,052.89 / $1,528.16
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,052.89 / $1,052.89 / $1,052.89
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$288.86 / $317.75 / $404.40