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Delaware 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
$799.60 / $799.60 / $124,638.57
Aetna
Facility/Professional
Professional
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
Highmark BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$876.00 / $876.00 / $876.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$292.82 / $305.02 / $457.53