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New Hampshire rates for HCPCS 79101

Radiopharmaceutical therapy, by intravenous administration

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$380.19 / $380.19 / $380.19
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$91.20 / $151.36 / $190.55
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$30.90 / $54.95 / $64.57
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$144.54 / $213.80 / $302.00
Anthem BCBS
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$53.70 / $75.86 / $109.65
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$186.21 / $331.13 / $436.52
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$69.18 / $125.89 / $165.96
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$165.96 / $281.84 / $446.68
Harvard Pilgrim
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$63.10 / $104.71 / $162.18
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$165.96 / $204.17 / $478.63
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$64.57 / $77.62 / $162.18
Well Sense
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$69.18 / $69.18 / $69.18