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New Hampshire rates for HCPCS A2009

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$66.07 / $79.43 / $131.83
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$53.70 / $69.18 / $102.33
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
$93.33 / $93.33 / $93.33
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$93.33 / $93.33 / $93.33
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$134.90 / $208.93 / $331.13
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$91.20 / $125.89 / $269.15
Well Sense
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,511.89 / $2,511.89 / $3,981.07