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Nevada 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
$303.80 / $565.91 / $803.69
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$296.48 / $303.80 / $311.13
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$279.08 / $320.27 / $973.01
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$283.39 / $305.02 / $311.13
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
Hometown Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$329.43 / $366.03 / $591.14
Hometown Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$327.41 / $327.41 / $327.41
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$305.02 / $305.02 / $347.73