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Hawaii rates for HCPCS A9513

Lutetium Lu 177, dotatate, therapeutic, 1 mCi

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$303.80 / $303.80 / $303.80
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$311.13 / $311.13 / $451.62
HMSA
Facility/Professional
Professional
Modifier
Low / Median / High Price
$316.97 / $316.97 / $331.91
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$358.16 / $417.28 / $486.82
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$305.02 / $451.62 / $457.53