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New Hampshire rates for HCPCS 77331

Special dosimetry (eg, TLD, microdosimetry) (specify), only when prescribed by the treating physician

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$158.49 / $158.49 / $158.49
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$47.86 / $67.61 / $107.15
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$32.36 / $47.86 / $151.36
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$15.14 / $19.05 / $28.84
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$46.77 / $46.77 / $46.77
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$64.57 / $91.20 / $131.83
Anthem BCBS
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$45.71 / $64.57 / $93.33
Anthem BCBS
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$19.50 / $26.92 / $38.90
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.43 / $144.54 / $194.98
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$54.95 / $100.00 / $138.04
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$24.55 / $43.65 / $58.88
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$75.86 / $131.83 / $204.17
Harvard Pilgrim
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$53.70 / $91.20 / $138.04
Harvard Pilgrim
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$22.39 / $38.02 / $58.88
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$66.07 / $87.10 / $218.78
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$41.69 / $58.88 / $134.90
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$21.38 / $25.12 / $58.88
Well Sense
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$33.88 / $33.88 / $33.88