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New Hampshire rates for HCPCS A9584

Iodine I-123 ioflupane, diagnostic, per study dose, up to 5 mCi

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,517.36 / $2,880.00 / $9,704.04
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,643.84 / $2,643.84 / $2,643.84
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,964.19 / $4,164.06 / $6,296.61
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,592.00 / $2,643.84 / $2,643.84
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,643.84 / $2,643.84 / $2,643.84
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,643.84 / $2,643.84 / $2,643.84
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,643.84 / $4,009.65 / $8,160.21
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,592.00 / $2,592.00 / $2,643.84
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,517.36 / $2,940.28 / $4,440.62