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Oklahoma 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
$290.67 / $296.48 / $578.42
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$292.82 / $296.48 / $303.80
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$122.37 / $193.51 / $309.66
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$311.13 / $311.13 / $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
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$290.67 / $312.69 / $415.66
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 / $336.35