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Georgia 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
$303.80 / $303.80 / $78,736.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$292.82 / $303.80 / $303.80
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$316.99 / $516.05 / $1,163.34
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$305.02 / $316.93 / $334.53
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$311.13 / $320.27 / $624.55
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$296.25 / $311.13 / $311.13
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$311.13 / $311.13 / $311.13
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$299.32 / $579.00 / $598.64
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$620.69 / $677.54 / $857.64
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$305.02 / $305.02 / $385.98