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Tennessee 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
$297.85 / $446.78 / $54,333.16
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$292.82 / $303.80 / $303.80
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$328.94 / $348.68 / $384.86
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$296.25 / $311.13 / $311.13
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$311.13 / $311.13 / $311.13
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$347.73 / $1,563.45 / $1,563.45
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,274.44 / $1,363.63 / $1,584.63
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$305.02 / $305.02 / $311.13