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Kansas 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
$366.03 / $11,485.50 / $134,273.42
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$252.56 / $292.82 / $366.03
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,236.18 / $6,013.61 / $7,845.74
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
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$287.08 / $335.38 / $428.29
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$305.02 / $305.02 / $1,274.44
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$305.02 / $305.02 / $366.03