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New Hampshire rates for HCPCS A9521

Technetium Tc-99m Exametazime Diagnostic Per Study Dose Up To 25 Millicuries

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,748.25 / $1,748.25 / $2,097.90
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,748.25 / $1,748.25 / $1,748.25
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,135.39 / $2,570.96 / $3,639.74
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,713.97 / $1,748.24 / $1,748.24
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,748.25 / $1,748.25 / $1,748.25
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,748.25 / $1,748.25 / $1,748.25
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,748.25 / $2,651.40 / $5,395.97
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,713.97 / $1,713.97 / $1,748.25
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,570.43 / $2,145.65 / $3,000.00