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New Hampshire rates for HCPCS Q4165

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$45.25 / $45.25 / $54.30
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$43.12 / $45.25 / $45.25
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.02 / $11.02 / $11.02
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$45.25 / $45.25 / $45.25
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$45.25 / $45.25 / $45.25
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$45.25 / $45.25 / $65.68
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$44.36 / $44.36 / $106.46
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.58 / $33.64 / $42.81