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New Hampshire rates for HCPCS A9517

Iodine I-131 Sodium Iodide Capsule(S) Therapeuticper Millicurie

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$36.40 / $36.40 / $6,633.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$29.56 / $36.40 / $53.95
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.02 / $60.83 / $104.93
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$36.40 / $41.80 / $41.80
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$88.54 / $88.54 / $88.54
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$88.54 / $88.54 / $88.54
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$36.40 / $36.40 / $60.62
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$36.40 / $42.84 / $42.84
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$40.04 / $50.97 / $3,375.00