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New Hampshire rates for HCPCS Q4154

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$131.83 / $131.83 / $158.49
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$131.83 / $131.83 / $162.18
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$125.89 / $125.89 / $125.89
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$123.03 / $131.83 / $131.83
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$131.83 / $131.83 / $131.83
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$131.83 / $131.83 / $213.80
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$125.89 / $131.83 / $371.54
Well Sense
Facility/Professional
Facility
Modifier
Low / Median / High Price
$380.19 / $380.19 / $616.60