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Massachusetts 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
$311.13 / $428.07 / $69,948.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$292.82 / $311.13 / $347.73
AllWays Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$347.73 / $831.55 / $983.78
AllWays Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$285.07 / $305.02 / $713.44
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$373.11 / $443.70 / $945.83
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 / $368.54
Fallon Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$312.69 / $494.05 / $8,090.00
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$311.13 / $311.13 / $466.70
Health New England
Facility/Professional
Facility
Modifier
Low / Median / High Price
$66,243.96 / $66,243.96 / $66,243.96
Mass General Brigham
Facility/Professional
Facility
Modifier
Low / Median / High Price
$347.73 / $347.73 / $1,563.45
Mass General Brigham
Facility/Professional
Professional
Modifier
Low / Median / High Price
$305.02 / $305.02 / $1,363.63
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$305.02 / $305.02 / $457.53