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New Hampshire rates for HCPCS Q4191

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$730.43 / $730.43 / $876.52
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$655.29 / $655.29 / $786.36
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$655.29 / $655.29 / $655.29
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$618.21 / $655.29 / $655.29
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$655.29 / $655.29 / $655.29
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$655.29 / $655.29 / $951.10
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$655.29 / $655.29 / $1,487.36
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$412.25 / $453.48 / $577.15