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Pennsylvania rates for HCPCS A9513

Lutetium Lu 177, dotatate, therapeutic, 1 mCi

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$311.13 / $713.75 / $150,955.01
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$292.82 / $311.13 / $311.13
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$295.57 / $347.73 / $8,459.92
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$347.73 / $347.73 / $347.73
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
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$264.45 / $311.13 / $311.13
Highmark BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$613.16 / $613.16 / $628.14
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$356.87 / $713.75 / $164,400.00
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$292.82 / $311.13 / $387.38
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$687.67 / $687.67 / $744.38
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$311.13 / $311.13 / $311.13
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$311.13 / $311.13 / $311.13
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$303.58 / $303.58 / $333.94
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$303.58 / $303.58 / $333.94
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$305.02 / $305.02 / $430.79