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New Hampshire rates for HCPCS 57180

Introduction of any hemostatic agent or pack for spontaneous or traumatic nonobstetrical vaginal hemorrhage (separate procedure)

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$108.27 / $147.38 / $391.91
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$125.62 / $213.06 / $370.16
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$202.14 / $298.16 / $585.19
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$154.00 / $335.62 / $667.44
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$207.03 / $294.20 / $798.37
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$91.05 / $127.47 / $194.42