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New Hampshire rates for HCPCS Q4117

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$24.39 / $24.39 / $29.27
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$23.24 / $24.39 / $24.39
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$24.38 / $24.38 / $27.80
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$24.39 / $24.39 / $24.39
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$24.39 / $24.39 / $24.39
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.91 / $16.91 / $24.54
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$25.44 / $28.69 / $28.69