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New Hampshire rates for HCPCS Q4134

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$137.77 / $137.77 / $165.32
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$131.28 / $137.77 / $137.77
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$162.08 / $162.08 / $162.08
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$162.08 / $162.08 / $162.08
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$162.08 / $162.08 / $162.08
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$162.08 / $162.08 / $235.24
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.11 / $162.08 / $162.08
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,500.00 / $2,750.00 / $3,500.00