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New Hampshire rates for HCPCS 77011

Computed tomography guidance for stereotactic localization

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$218.78 / $218.78 / $218.78
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$173.78 / $263.03 / $457.09
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$44.67 / $66.07 / $85.11
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$128.82 / $186.21 / $398.11
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$158.49 / $158.49 / $158.49
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$223.87 / $316.23 / $446.68
Anthem BCBS
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$60.26 / $87.10 / $125.89
Anthem BCBS
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$162.18 / $223.87 / $323.59
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$281.84 / $512.86 / $933.25
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$77.62 / $134.90 / $181.97
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$204.17 / $380.19 / $676.08
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$257.04 / $436.52 / $630.96
Harvard Pilgrim
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$69.18 / $117.49 / $169.82
Harvard Pilgrim
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$186.21 / $316.23 / $489.78
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$275.42 / $407.38 / $741.31
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$54.95 / $81.28 / $181.97
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$199.53 / $295.12 / $616.60
Well Sense
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$45.71 / $45.71 / $45.71