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New Hampshire rates for HCPCS Q4218

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$127.50 / $127.50 / $153.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$121.50 / $127.50 / $127.50
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$127.50 / $127.50 / $127.50
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$127.50 / $127.50 / $127.50
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$127.50 / $127.50 / $127.50
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$127.50 / $127.50 / $185.05
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$127.50 / $150.00 / $150.00
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$127.50 / $140.25 / $178.50