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New Hampshire rates for HCPCS 43204

Esophagoscopy Flex Transoral Injection Varices

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $838.94 / $2,331.21
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$143.47 / $170.42 / $243.28
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,449.90 / $1,611.00 / $2,875.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$130.03 / $234.30 / $373.16
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,306.21 / $1,306.21 / $1,351.93
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$176.39 / $293.04 / $491.47
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$148.86 / $261.44 / $490.36
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$930.00 / $3,884.00 / $8,611.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$169.61 / $237.62 / $439.27
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$106.14 / $116.75 / $148.60