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Wisconsin rates for HCPCS A9513

Lutetium Lu 177, dotatate, therapeutic, 1 mCi

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$292.82 / $292.82 / $640.19
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$292.82 / $292.82 / $366.03
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$586.42 / $681.53 / $706.89
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$305.02 / $305.02 / $305.02
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$293.91 / $350.96 / $642.04
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$249.23 / $357.10 / $405.80
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$292.82 / $292.82 / $358.85
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$287.08 / $305.02 / $358.85
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$305.02 / $305.02 / $640.54
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.00 / $70.00 / $7,695.00
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$292.82 / $292.82 / $358.85
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$311.13 / $311.13 / $1,481.25
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$311.13 / $373.27 / $1,274.44
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$305.02 / $305.02 / $427.03