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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
$131.83 / $162.18 / $194.98
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$151.36 / $158.49 / $190.55
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$125.89 / $125.89 / $125.89
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$162.18 / $162.18 / $162.18
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$162.18 / $162.18 / $162.18
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$66.07 / $66.07 / $123.03
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$66.07 / $125.89 / $165.96
Well Sense
Facility/Professional
Facility
Modifier
Low / Median / High Price
$162.18 / $162.18 / $257.04