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New Hampshire rates for HCPCS Q4180

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,090.07 / $1,090.07 / $1,308.08
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$656.12 / $656.12 / $1,090.07
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$656.12 / $656.12 / $656.12
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$618.98 / $656.12 / $656.12
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$656.12 / $656.12 / $656.12
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$656.12 / $656.12 / $952.29
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$656.12 / $656.12 / $1,417.97
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$226.02 / $248.62 / $316.43