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New Hampshire rates for HCPCS Q4219

Surgigraft-Dual Per Square Centimeter

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,020.00 / $1,020.00 / $1,224.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$972.00 / $1,020.00 / $1,020.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$100.84 / $100.84 / $100.84
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,020.00 / $1,020.00 / $1,020.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,020.00 / $1,020.00 / $1,020.00
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,020.00 / $1,020.00 / $1,480.43
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$788.99 / $788.99 / $1,020.00
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$100.84 / $110.92 / $141.18