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Missouri rates for HCPCS A9513

Lutetium Lu 177, dotatate, therapeutic, 1 mCi

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$292.82 / $376.79 / $11,485.50
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$292.82 / $292.82 / $303.80
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$316.99 / $518.53 / $1,138.63
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$264.11 / $281.70 / $352.14
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 / $340.91 / $1,481.25
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$276.04 / $305.02 / $475.53
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$305.02 / $305.02 / $366.03