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New Hampshire rates for HCPCS Q4195

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$107.92 / $107.92 / $129.50
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$97.94 / $97.94 / $117.53
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$111.65 / $352.58 / $444.30
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$97.94 / $97.94 / $97.94
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$92.40 / $97.94 / $97.94
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$97.94 / $97.94 / $97.94
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$97.94 / $97.94 / $142.15
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$97.94 / $97.94 / $180.09
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$192.98 / $241.41 / $3,375.00