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New Hampshire rates for HCPCS Q9965

Low osmolar contrast material, 100-199 mg/ml iodine concentration, per ml

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.05 / $1.26 / $165.96
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.00 / $1.00 / $2.75
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.45 / $2.45 / $2.45
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.48 / $2.19 / $3.80
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.05 / $1.05 / $1.05
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.98 / $1.05 / $1.05
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.05 / $1.05 / $1.05
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.15 / $1.15 / $1.95
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.87 / $1.05 / $1.05
Well Sense
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.68 / $0.68 / $0.68