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Minnesota 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 / $366.03 / $366.03
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$292.82 / $311.13 / $366.03
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$282.27 / $311.12 / $584.41
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$248.90 / $301.79 / $311.12
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$244.54 / $301.31 / $748.91
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$237.48 / $293.91 / $311.13
Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$235.13 / $303.32 / $857.74
Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$235.13 / $235.13 / $268.04
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$305.02 / $358.85 / $613.64
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$305.02 / $305.02 / $699.69
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$305.02 / $305.02 / $552.94