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New Hampshire rates for HCPCS A9596

Gallium Ga-68 Gozetotide Diagnostic (Illuccix) 1 Millicurie

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,053.84 / $8,455.19 / $25,588.68
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,029.06 / $1,053.85 / $1,053.85
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$754.49 / $1,841.58 / $2,320.60
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,033.20 / $1,053.85 / $1,053.85
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,053.85 / $1,053.85 / $1,053.85
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,053.85 / $1,053.85 / $1,053.85
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,053.85 / $1,053.85 / $1,529.57
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,033.20 / $1,033.20 / $1,053.85
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,750.00 / $2,920.00 / $3,000.00