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New Hampshire rates for HCPCS A9507

Indium In 111 Capromab Pendetide Diagnostic Per Study Dose Up To 10 Millicuries Special Coverage Instructions Apply. See Mcm: 1502

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,483.93 / $4,483.93 / $5,380.72
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,483.93 / $4,483.93 / $5,254.10
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.02 / $0.02 / $0.04
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,471.30 / $1,730.95 / $1,730.95
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,483.93 / $4,483.93 / $4,483.93
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,483.93 / $4,483.93 / $4,483.93
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,483.93 / $6,800.33 / $13,839.65
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,275.21 / $5,275.21 / $5,275.21
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,483.93 / $4,932.32 / $6,277.50