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New Hampshire rates for HCPCS A9521

Technetium Tc-99m exametazime, diagnostic, per study dose, up to 25 mCi

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,737.80 / $1,737.80 / $2,089.30
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,412.54 / $1,737.80 / $1,737.80
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,318.26 / $3,235.94 / $6,309.57
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,698.24 / $1,737.80 / $1,995.26
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,737.80 / $1,737.80 / $1,737.80
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,737.80 / $1,737.80 / $1,737.80
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,737.80 / $1,737.80 / $3,311.31
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,698.24 / $1,698.24 / $1,737.80