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Nebraska 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 / $703.55 / $809.07
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$292.82 / $292.82 / $96,355.52
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$69,575.62 / $91,510.96 / $177,011.74
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 / $312.69 / $1,481.25
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$299.04 / $305.02 / $457.53
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$329.07 / $533.25 / $696.19
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$329.07 / $329.07 / $329.07
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$289.77 / $305.02 / $366.03