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New Hampshire rates for HCPCS Q4153

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$108.60 / $108.60 / $130.32
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$130.32 / $137.93 / $151.72
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$137.93 / $137.93 / $137.93
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$130.12 / $137.93 / $137.93
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$137.93 / $137.93 / $137.93
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$137.93 / $137.93 / $200.19
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$137.93 / $137.93 / $331.03