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Louisiana 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
$358.85 / $538.28 / $1,087.32
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$366.03 / $366.03 / $366.03
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$273.60 / $322.97 / $393.97
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$322.97 / $322.97 / $329.43
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
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$298.92 / $305.02 / $475.84