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New Hampshire rates for HCPCS A4257

Replacement lens shield cartridge for use with laser skin piercing device, each

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$9.36 / $9.36 / $11.24
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.79 / $9.36 / $12.04
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.50 / $6.50 / $7.65
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$20.89 / $20.89 / $20.89
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.28 / $7.28 / $7.28
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$14.53 / $14.53 / $22.04
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.93 / $8.89 / $14.20
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$14.10 / $15.51 / $19.73