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New Hampshire rates for HCPCS 76873

Ultrasound, transrectal; prostate volume study for brachytherapy treatment planning (separate procedure)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$281.84 / $281.84 / $281.84
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$134.90 / $177.83 / $363.08
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$60.26 / $77.62 / $186.21
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$177.83 / $199.53 / $288.40
Anthem BCBS
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$75.86 / $83.18 / $125.89
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$199.53 / $302.00 / $489.78
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$89.13 / $134.90 / $218.78
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$208.93 / $309.03 / $478.63
Harvard Pilgrim
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$89.13 / $134.90 / $204.17
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$181.97 / $234.42 / $457.09
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$79.43 / $104.71 / $194.98