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New Hampshire rates for HCPCS A2001

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$131.83 / $1,288.25 / $1,513.56
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,202.26 / $1,258.93 / $1,513.56
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$125.89 / $125.89 / $125.89
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,288.25 / $1,288.25 / $1,288.25
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,288.25 / $1,288.25 / $1,288.25
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$138.04 / $208.93 / $331.13
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$125.89 / $208.93 / $1,258.93
Well Sense
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,288.25 / $1,288.25 / $2,041.74