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New Hampshire rates for HCPCS 74177

Ct Abdomen & Pelvis W/Contrast Material

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$80.62 / $80.62 / $165.26
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$246.11 / $319.82 / $785.63
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$67.81 / $80.62 / $205.06
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$178.29 / $239.19 / $580.55
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$228.01 / $243.87 / $723.08
Ambetter
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$63.81 / $69.76 / $275.66
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$297.26 / $635.12 / $910.69
Anthem BCBS
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$83.45 / $178.30 / $252.15
Anthem BCBS
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$213.81 / $456.82 / $646.03
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$396.29 / $658.64 / $953.25
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$106.76 / $174.70 / $254.97
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$287.29 / $483.95 / $698.28
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$340.31 / $604.79 / $1,121.02
Harvard Pilgrim
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$95.54 / $169.79 / $314.72
Harvard Pilgrim
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$244.77 / $434.08 / $806.30
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$375.02 / $446.37 / $851.97
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$90.37 / $121.51 / $246.22
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$263.95 / $339.90 / $750.29
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$261.97 / $314.36 / $462.12
Well Sense
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$69.68 / $83.53 / $116.59
Well Sense
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$191.78 / $228.22 / $332.04