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New Hampshire rates for HCPCS Q4161

bio-ConneKt wound matrix, per sq cm (add-on, list separately in addition to primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,653.82 / $1,653.82 / $1,984.58
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,590.54 / $1,590.54 / $1,908.65
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,590.54 / $1,590.54 / $1,590.54
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,500.51 / $1,590.54 / $1,590.54
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,590.54 / $1,590.54 / $1,590.54
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,590.54 / $1,590.54 / $2,308.51
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,590.54 / $1,590.54 / $2,446.78
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,500.00 / $2,750.00 / $3,500.00