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New Hampshire rates for HCPCS 95958

Wada activation test for hemispheric function, including electroencephalographic (EEG) monitoring

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,058.90 / $1,191.00 / $1,191.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$469.04 / $588.54 / $765.83
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$668.80 / $1,002.50 / $1,563.90
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$492.64 / $1,018.26 / $2,019.13
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$788.00 / $1,296.26 / $2,432.16
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$438.37 / $857.99 / $1,991.27
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$382.84 / $535.59 / $821.55