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New Hampshire rates for HCPCS 74775

Perineogram (eg, vaginogram, for sex determination or extent of anomalies)

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$165.96 / $223.87 / $295.12
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$251.19 / $398.11 / $537.03
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$288.40 / $512.86 / $1,412.54
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$104.71 / $158.49 / $245.47
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$107.15 / $173.78 / $295.12
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$102.33 / $316.23 / $660.69
Well Sense
Facility/Professional
Facility
Modifier
Low / Median / High Price
$75.86 / $75.86 / $75.86