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Virginia 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
$311.13 / $610.04 / $986.80
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$279.48 / $311.13 / $311.13
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$316.99 / $668.85 / $1,077.77
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$292.82 / $292.82 / $390.85
CareFirst
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
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$295.57 / $354.68 / $417.28
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$311.13 / $366.03 / $547.59
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$305.02 / $305.02 / $366.03