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New Hampshire rates for HCPCS A9504

Technetium Tc-99m Apcitide Diagnostic Per Study Dose Up To 20 Millicuries

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$425.00 / $425.00 / $510.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$425.00 / $425.00 / $498.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$400.00 / $412.82 / $412.82
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$432.81 / $432.81 / $432.81
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$432.81 / $432.81 / $432.81
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$475.00 / $720.38 / $1,466.09
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$500.00 / $500.00 / $500.00
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$344.88 / $379.37 / $482.83