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New Hampshire rates for HCPCS A2013

InnovaMatrix FS, 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 / $1,380.38 / $1,659.59
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,288.25 / $1,348.96 / $1,621.81
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
$1,380.38 / $1,380.38 / $1,380.38
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,380.38 / $1,380.38 / $1,380.38
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,380.38 / $2,041.74 / $3,019.95
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$125.89 / $1,348.96 / $2,630.27
Well Sense
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,380.38 / $1,380.38 / $2,187.76