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New Hampshire rates for HCPCS Q4143

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$33.92 / $33.92 / $40.70
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$33.92 / $33.92 / $40.70
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$33.92 / $33.92 / $33.92
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$32.00 / $33.92 / $33.92
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$33.92 / $33.92 / $33.92
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$33.92 / $33.92 / $49.23
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$33.92 / $33.92 / $33.92
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,500.00 / $2,750.00 / $3,500.00