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New Hampshire rates for HCPCS 0577T

Electrophysiologic evaluation of implantable cardioverter-defibrillator system with substernal electrode (includes defibrillation threshold evaluation, induction of arrhythmia, evaluation of sensing for arrhythmia termination, and programming or reprogramming of sensing or therapeutic parameters)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $100.00 / $9,859.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$199.99 / $199.99 / $220.88
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$383.64 / $707.85 / $988.51
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$272.17 / $518.54 / $896.56
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$259.99 / $333.29 / $600.27
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,500.00 / $2,750.00 / $3,500.00