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Zenith Amniotic Membrane

New Hampshire rates for HCPCS Q4253

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

Rates data updated July 2026.

How much does Zenith Amniotic Membrane cost?

$75.86

Typical negotiated rate. In New Hampshire, July 2026.

Insurers have agreed to pay about $75.86 for this service. The price depends on where it is billed: about $75.86 from a physician practice, and about $91.20 from a hospital or other facility. The two figures are alternatives, not parts of one bill.

These are rates insurers have negotiated with providers, not the amount a patient is billed. What you owe depends on your plan's deductible and coinsurance. Based on rates published by 6 insurance carriers under federal price transparency rules.

Where it's billed changes the price

Billed byTypicalRange
Physician practiceA doctor's office, clinic or independent provider$75.86$75.86 to $126
FacilityA hospital or hospital-owned outpatient department$91.20$75.86 to $162

How much rates vary

Facilitymedian $91 · 10th to 90th $76 to $295Professionalmedian $76 · 10th to 90th $76 to $132
$100$200facility $91professional $76

Distribution of negotiated rates across all payers (price axis is log-scale). Each curve is scaled to its own total: facility and professional rates are different services, shown together to compare where they cluster. Need provider-level prices or 24+ months of history? Contact us.

Rates by insurance carrier

Insurance Carrier
Aetna
Setting
Facility
Modifier
Global
Typical Low
$75.86
Median
$75.86
Typical High
$131.83
Aetna
Setting
Professional
Modifier
Global
Typical Low
$75.86
Median
$75.86
Typical High
$91.20
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$125.89
Typical High
$165.96
Cigna
Setting
Facility
Modifier
Global
Typical Low
$144.54
Median
$251.19
Typical High
$338.84
Cigna
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$125.89
Typical High
$125.89
Harvard Pilgrim
Setting
Professional
Modifier
Global
Typical Low
$75.86
Median
$75.86
Typical High
$125.89
United
Setting
Facility
Modifier
Global
Typical Low
$208.93
Median
$208.93
Typical High
$208.93
United
Setting
Professional
Modifier
Global
Typical Low
$75.86
Median
$125.89
Typical High
$128.82
Well Sense
Setting
Facility
Modifier
Global
Typical Low
$117.49
Median
$144.54
Typical High
$162.18
Well Sense
Setting
Professional
Modifier
Global
Typical Low
$2,511.89
Median
$2,511.89
Typical High
$2,511.89

Where New Hampshire sits

The same service costs 2.5 times more in Alaska than in Maryland. Every bar is a state, most expensive first. Touch or drag across it to read any state, then open that state for its carriers and full range.

New Hampshire· 38th of 51

$75.86

AK $191MD $75.86

Median negotiated rate in each state, from every insurer that publishes one. States where no insurer publishes a rate for this service are not shown.