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New Hampshire rates for HCPCS 93923

Complete bilateral noninvasive physiologic studies of upper or lower extremity arteries, 3 or more levels (eg, for lower extremity: ankle/brachial indices at distal posterior tibial and anterior tibial/dorsalis pedis arteries plus segmental blood pressure measurements with bidirectional Doppler waveform recording and analysis, at 3 or more levels, or ankle/brachial indices at distal posterior tibial and anterior tibial/dorsalis pedis arteries plus segmental volume plethysmography at 3 or more levels, or ankle/brachial indices at distal posterior tibial and anterior tibial/dorsalis pedis arteries plus segmental transcutaneous oxygen tension measurements at 3 or more levels), or single level study with provocative functional maneuvers (eg, measurements with postural provocative tests, or measurements with reactive hyperemia)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$179.16 / $546.23 / $995.62
Aetna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$22.80 / $49.86 / $70.70
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$143.71 / $179.17 / $495.53
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$20.76 / $22.81 / $58.85
Aetna
Facility/Professional
Professional
Modifier
52
Low / Median / High Price
$71.86 / $71.86 / $89.59
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$122.95 / $156.37 / $436.71
Ambetter
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$7.02 / $16.29 / $18.32
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$125.83 / $142.76 / $248.61
Anthem BCBS
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$20.38 / $23.12 / $37.29
Anthem BCBS
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$105.45 / $119.64 / $207.92
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$499.54 / $873.18 / $941.66
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$148.09 / $247.20 / $361.16
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$23.32 / $37.90 / $56.58
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$124.77 / $207.22 / $303.75
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$144.05 / $256.01 / $474.52
Harvard Pilgrim
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$23.33 / $40.36 / $72.01
Harvard Pilgrim
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$120.72 / $212.02 / $372.60
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$153.80 / $230.23 / $470.32
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$23.33 / $35.38 / $75.01
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$120.72 / $194.66 / $379.89
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$117.68 / $147.19 / $202.62
Well Sense
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$16.93 / $20.22 / $27.26
Well Sense
Facility/Professional
Professional
Modifier
52
Low / Median / High Price
$38.02 / $45.62 / $51.33
Well Sense
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$90.05 / $111.66 / $170.55