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New Hampshire rates for HCPCS Q4199

Cygnus matrix, per square centimeter

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$130.26 / $130.26 / $156.31
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$111.15 / $111.15 / $133.38
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$111.15 / $111.15 / $111.15
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$104.86 / $111.15 / $111.15
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$111.15 / $111.15 / $111.15
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$111.15 / $111.15 / $161.32
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$111.15 / $111.15 / $266.76
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$402.90 / $443.19 / $564.05