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New Hampshire rates for HCPCS Q4225

AmnioBind or DermaBind TL, per sq cm (add-on, list separately in addition to primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,370.73 / $1,370.73 / $1,644.88
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,427.45 / $1,427.45 / $1,644.88
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,427.45 / $1,427.45 / $1,427.45
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,346.65 / $1,427.45 / $1,427.45
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,427.45 / $1,427.45 / $1,427.45
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,427.45 / $1,427.45 / $2,071.80
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,427.45 / $1,427.45 / $1,488.37
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,500.00 / $2,750.00 / $3,500.00