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New Hampshire rates for HCPCS Q4170

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$41.55 / $41.55 / $49.86
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$39.31 / $39.31 / $47.18
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$39.31 / $39.31 / $39.31
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$37.09 / $39.31 / $39.31
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$39.31 / $39.31 / $39.31
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$39.31 / $39.31 / $57.05
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$39.31 / $39.31 / $94.34
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$205.91 / $226.50 / $288.27