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Mississippi 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
$300.14 / $430.62 / $581.34
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$300.14 / $439.24 / $439.24
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$239.40 / $239.40 / $251.54
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 / $366.03
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$25.00 / $266.62 / $296.25
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$292.82 / $305.02 / $396.53