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New Hampshire rates for HCPCS 15004

Prep Site F/S/N/H/F/G/M/D Gt 1st 100 Sq Cm/1pct

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$456.14 / $1,414.97 / $3,445.59
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$232.12 / $307.07 / $610.90
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,223.09 / $1,359.00 / $3,300.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$252.63 / $436.39 / $735.10
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,751.69 / $1,751.69 / $1,812.99
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$282.82 / $537.42 / $981.63
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$329.51 / $683.67 / $1,221.36
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7,448.00 / $7,448.00 / $7,448.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$393.03 / $611.86 / $1,407.89
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$213.47 / $317.52 / $444.54