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Florida 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 / $321.68 / $122,784.64
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$292.82 / $303.80 / $311.13
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
Florida Blue
Facility/Professional
Facility
Modifier
Low / Median / High Price
$330.14 / $330.14 / $330.14
Florida Blue
Facility/Professional
Professional
Modifier
Low / Median / High Price
$231.10 / $330.14 / $330.14
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$40.00 / $50.00 / $70.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$305.02 / $305.02 / $314.17
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$330.14 / $349.95 / $349.95