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New Hampshire rates for HCPCS G9877

Two Medicare Diabetes Prevention Program (MDPP) core maintenance sessions (MS) were attended by an MDPP beneficiary in months (mo) 10-12 under the MDPP Expanded Model (EM).

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$14.25 / $14.25 / $14.25
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.95 / $14.25 / $72.20
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.77 / $6.77 / $6.77
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.55 / $11.55 / $11.55
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.55 / $25.58 / $48.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.00 / $21.75 / $48.74
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,500.00 / $2,750.00 / $3,500.00