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Connecticut 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
$311.13 / $573.75 / $1,098.08
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$305.02 / $311.13 / $311.13
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$326.39 / $463.69 / $914.30
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$305.02 / $305.02 / $311.12
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
ConnectiCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$311.13 / $311.13 / $311.13
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$289.77 / $305.02 / $336.75