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New Hampshire rates for HCPCS A2002

Mirragen Advanced Wound Matrix, per sq cm (add-on, list separately in addition to primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$129.62 / $129.62 / $155.54
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$114.85 / $129.62 / $151.56
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.06 / $7.06 / $7.06
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$200.58 / $200.58 / $200.58
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$147.91 / $147.91 / $147.91
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$342.87 / $342.87 / $342.87
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,500.00 / $2,750.00 / $3,500.00