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New Hampshire rates for HCPCS 49426

Revis Peritoneal-Venous Shunt

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $2,254.73 / $2,341.64
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$583.58 / $649.09 / $866.93
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,302.10 / $3,669.00 / $6,000.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$658.25 / $1,180.77 / $1,889.03
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,751.69 / $1,751.69 / $1,812.99
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$674.11 / $1,246.08 / $2,023.05
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$753.56 / $1,303.51 / $2,325.86
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$854.00 / $4,487.00 / $9,949.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$701.94 / $994.43 / $4,131.28
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$526.66 / $579.34 / $737.34