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New Hampshire rates for HCPCS A5121

Skin Barrier; Solid 6 X 6 Or Equivalent Each (Special Coverage Instructions Apply. See Mcm: 2130)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.17 / $5.17 / $6.20
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.85 / $4.51 / $5.31
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.44 / $4.44 / $4.44
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.26 / $6.26 / $6.89
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.32 / $5.32 / $7.36
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8.43 / $8.43 / $26.02
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.27 / $4.91 / $6.28
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.94 / $7.63 / $9.72