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New Hampshire rates for HCPCS Q4108

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$49.12 / $49.12 / $58.94
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$38.54 / $38.54 / $49.12
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$38.54 / $38.54 / $38.54
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$36.36 / $38.54 / $38.54
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$38.54 / $38.54 / $38.54
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$38.54 / $38.54 / $55.94
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$38.54 / $38.54 / $82.73
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$47.54 / $52.29 / $66.56