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Iowa 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
$502.39 / $809.07 / $1,066.96
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$292.82 / $292.82 / $292.82
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$235.13 / $293.91 / $311.13
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$150.00 / $433.67 / $508.50
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$312.69 / $329.07 / $485.17
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$305.02 / $305.02 / $531.16
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$444.38 / $518.44 / $696.19
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$329.07 / $329.07 / $329.07
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$620.69 / $806.68 / $909.85
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$305.02 / $305.02 / $335.52
Wellmark
Facility/Professional
Facility
Modifier
Low / Median / High Price
$299.04 / $299.04 / $299.04
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$236.24 / $299.04 / $299.04