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New Hampshire rates for HCPCS Q4102

Oasis 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
$11.75 / $14.13 / $131.83
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.96 / $10.96 / $15.85
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.20 / $30.90 / $34.67
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$11.22 / $11.75 / $11.75
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.75 / $11.75 / $11.75
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.75 / $11.75 / $21.88
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.75 / $30.20 / $125.89
Well Sense
Facility/Professional
Facility
Modifier
Low / Median / High Price
$11.48 / $11.48 / $18.20