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Oregon 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
$305.02 / $305.02 / $732.06
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$303.80 / $303.80 / $303.80
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$296.25 / $296.25 / $610.04
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$311.13 / $311.13 / $311.13
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$303.80 / $394.74 / $653.16
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$348.69 / $412.09 / $792.48
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$334.53 / $334.53 / $79,999.20
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$303.80 / $402.63 / $653.16
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$311.13 / $390.45 / $431.41
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$281.89 / $422.84 / $1,059.08
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$347.73 / $347.73 / $347.73
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$305.02 / $305.02 / $350.77