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New Hampshire rates for HCPCS 96004

Phys/Qhp R&I Cptr Mtn Alys Walk/Funcjl Actv Repr

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$154.46 / $341.07 / $341.07
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$98.87 / $111.58 / $140.41
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$102.54 / $149.34 / $238.39
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$117.97 / $189.04 / $279.47
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$117.39 / $193.11 / $362.32
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$122.54 / $171.42 / $335.05
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$87.84 / $105.41 / $154.94