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North Dakota 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
$292.82 / $292.82 / $549.04
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$292.82 / $303.80 / $366.03
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$320.27 / $321.87 / $326.00
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$272.23 / $321.39 / $326.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$235.13 / $293.91 / $311.13
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$287.08 / $373.20 / $613.64
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$299.04 / $305.02 / $1,274.44
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$305.02 / $305.02 / $335.52