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New Hampshire rates for HCPCS 74713

Fetal Mri W/Placntl Matrnl Plvc Img Ea Addl Ges

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$309.74 / $309.74 / $309.74
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$325.05 / $400.00 / $425.00
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$828.51 / $1,041.21 / $1,156.67
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$195.70 / $418.12 / $599.54
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$658.61 / $913.59 / $1,407.77
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$259.77 / $431.16 / $622.01
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$224.03 / $375.41 / $691.47
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$226.52 / $306.81 / $632.91
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$212.15 / $233.37 / $297.01