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New Hampshire rates for HCPCS Q4176

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$161.50 / $161.50 / $193.80
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$153.90 / $161.50 / $161.50
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$65.92 / $65.92 / $65.92
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$161.50 / $161.50 / $161.50
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$161.50 / $161.50 / $161.50
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$65.92 / $65.92 / $95.68
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$167.51 / $167.51 / $167.51
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$161.50 / $177.65 / $226.10