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New Hampshire rates for HCPCS Q4169

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,220.57 / $2,220.57 / $2,664.68
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,068.46 / $2,068.46 / $2,482.17
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,068.46 / $2,068.46 / $2,068.46
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,951.39 / $2,068.46 / $2,068.46
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,068.46 / $2,068.46 / $2,068.46
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,068.46 / $2,068.46 / $3,002.18
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,068.46 / $2,068.46 / $2,919.63
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$402.90 / $443.19 / $564.05