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New Hampshire rates for HCPCS 49400

Injection Air/Contrast Peritoneal Cavity Spx

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $377.41 / $2,331.21
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$91.86 / $136.62 / $175.35
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$103.75 / $167.86 / $282.95
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$125.20 / $226.58 / $427.55
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$107.42 / $211.51 / $437.01
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$75.00 / $3,360.00 / $7,448.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$147.58 / $256.02 / $538.57
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.31 / $125.04 / $179.27