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New Hampshire rates for HCPCS 74400

Urography (pyelography), intravenous, with or without KUB, with or without tomography

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$89.13 / $89.13 / $89.13
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$93.33 / $128.82 / $275.42
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$18.62 / $21.88 / $50.12
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$131.83 / $208.93 / $275.42
Anthem BCBS
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$22.91 / $35.48 / $51.29
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$141.25 / $204.17 / $407.38
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$27.54 / $46.77 / $69.18
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$151.36 / $239.88 / $363.08
Harvard Pilgrim
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$26.30 / $40.74 / $60.26
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$109.65 / $173.78 / $331.13
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$23.99 / $32.36 / $61.66
Well Sense
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$14.79 / $17.38 / $17.38