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Colorado rates for HCPCS A9513

Lutetium Lu 177 Dotate Therapeutic 1 Millicurie(Reinstated Code) Supply Of Radiopharmaceutical Diagnostic Imaging Agent Technitium Tc-99m Mebrofenin Per Mci (Old Description Deleted 12/31/2005)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$292.82 / $513.87 / $1,108.13
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$287.08 / $292.82 / $347.73
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$335.06 / $535.54 / $976.06
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$249.39 / $249.39 / $689.49
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$311.13 / $311.13 / $311.13
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$311.13 / $311.13 / $311.13
Denver HMP
Facility/Professional
Facility
Modifier
Low / Median / High Price
$292.82 / $311.13 / $503.06
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$787.00 / $60,000.00 / $60,000.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$305.02 / $305.02 / $305.02