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New Hampshire rates for HCPCS A9502

Technetium Tc-99m tetrofosmin, diagnostic, per study dose

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$87.10 / $524.81 / $2,630.27
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$70.79 / $85.11 / $229.09
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$120.23 / $120.23 / $120.23
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$120.23 / $177.83 / $309.03
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$85.11 / $87.10 / $100.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$87.10 / $87.10 / $87.10
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$87.10 / $87.10 / $87.10
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$87.10 / $87.10 / $165.96
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$85.11 / $85.11 / $89.13