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New Hampshire rates for HCPCS A9509

Iodine I-123 sodium iodide, diagnostic, per mCi

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,862.09 / $1,862.09 / $2,238.72
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$102.33 / $1,513.56 / $1,862.09
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
$794.33 / $794.33 / $794.33
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$147.91 / $147.91 / $147.91
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$147.91 / $147.91 / $147.91
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,862.09 / $1,862.09 / $3,548.13
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,862.09 / $2,187.76 / $2,187.76