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New Hampshire rates for HCPCS Q4256

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$813.21 / $813.21 / $975.85
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$735.05 / $735.05 / $882.05
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$735.05 / $735.05 / $735.05
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$693.44 / $735.05 / $735.05
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$735.05 / $735.05 / $735.05
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$735.05 / $735.05 / $1,066.84
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$735.05 / $735.05 / $1,764.12
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,500.00 / $2,750.00 / $3,500.00