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New Hampshire rates for HCPCS G0279

Diagnostic digital breast tomosynthesis, unilateral or bilateral (list separately in addition to 77065 or 77066)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$27.64 / $29.46 / $29.47
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$36.01 / $52.97 / $58.72
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$20.69 / $27.39 / $31.55
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$15.74 / $25.58 / $28.14
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$33.45 / $45.09 / $102.85
Ambetter
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$21.05 / $31.79 / $64.89
Ambetter
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$37.29 / $37.29 / $37.29
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$42.70 / $64.79 / $90.90
Anthem BCBS
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$27.49 / $40.36 / $57.09
Anthem BCBS
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$15.20 / $24.43 / $36.88
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$39.28 / $39.28 / $39.28
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$25.29 / $25.29 / $25.29
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$13.99 / $13.99 / $13.99
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$24.81 / $38.36 / $76.58
Harvard Pilgrim
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$15.92 / $28.29 / $52.44
Harvard Pilgrim
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$8.89 / $13.16 / $23.55
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$57.32 / $71.19 / $106.29
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$31.47 / $38.49 / $81.06
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$22.71 / $34.22 / $71.00
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$43.32 / $58.48 / $7,080.00
Well Sense
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$22.87 / $26.90 / $40.61
Well Sense
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$20.14 / $23.70 / $35.79