APC 9054

Lutetium Lu-177 vipivotide tetraxetan

Hospitals report these codes with terse, inconsistent chargemaster text. This plain-English title was written by an AI model from that text and has not been reviewed by a person, so it can be wrong. The prices on this page come straight from hospital filings and do not depend on it.

Model: claude-haiku-5-5
Provider: anthropic
API: message_batches
Reasoning effort: low
Max output tokens: 4096
Prompt version (hash): 444523875572
Generated: October 20, 2026

Original text from hospital filings

Lutetium lu 177 vipivotide

Payers reporting APC 9054

Payer pricing summary

Low

$134

Average

$1.3k

Median

$273

High

$28.3k

Payer rate distribution

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#
1	Excellus case rate · outpatient	4	$349	$357	$131	37%	2–20	$256 – $574
2	Caresource other · outpatient	1	$28.3k	$28.3k	—	—	1–10	$28.3k – $28.3k
3	UnitedHealthcare fee schedule · outpatient · +3 other terms	174	$262	$261	$6	2%	—	$230 – $273
4	Humana fee schedule · outpatient · +5 other terms	161	$259	$271	$74	27%	—	$230 – $1.0k
5	Aetna fee schedule · outpatient · +4 other terms	155	$262	$266	$28	11%	—	$230 – $422
6	WellCare fee schedule · outpatient · +2 other terms	131	$267	$271	$11	4%	—	$241 – $342
7	Blue Cross Blue Shield fee schedule · outpatient · +3 other terms	126	$265	$263	$9	3%	—	$240 – $360
8	Devoted fee schedule · outpatient · +1 other terms	122	$259	$260	$2	1%	—	$259 – $272
9	Cigna Healthspring fee schedule · outpatient · +1 other terms	110	$270	$266	$7	3%	—	$259 – $289
10	Molina fee schedule · outpatient · +2 other terms	69	$382	$371	$143	39%	—	$241 – $679
11	Superior Healthplan fee schedule · outpatient	40	$272	$273	$2	1%	—	$272 – $281
12	Anthem fee schedule · outpatient · +1 other terms	31	$259	$258	$9	3%	—	$241 – $267
13	Oscar fee schedule · outpatient · +1 other terms	27	$254	$280	$51	18%	—	$254 – $422
14	Amerihealth Caritas fee schedule · outpatient	17	$311	$310	$2	1%	—	$305 – $311
15	Cigna fee schedule · outpatient · +2 other terms	15	$265	$260	$14	5%	—	$241 – $280
16	Clover fee schedule · outpatient · +2 other terms	15	$273	$273	$2	1%	—	$272 – $281
17	Kaiser fee schedule · outpatient · +2 other terms	15	$265	$262	$6	2%	—	$246 – $265
18	Ambetter case rate · outpatient · +3 other terms	12	$461	$499	$46	9%	—	$461 – $554
19	Medicare case rate · outpatient · +1 other terms	8	$256	$256	—	—	—	$256 – $256
20	Optum fee schedule · outpatient · +3 other terms	8	$263	$392	$186	48%	—	$256 – $668
21	Highmark case rate · outpatient · +1 other terms	5	$256	$346	$123	35%	—	$256 – $561
22	Tricare facility · fee schedule · outpatient	5	$256	$256	—	—	—	$256 – $256
23	Sanford Health Plan case rate · outpatient	3	$367	$369	$37	10%	—	$307 – $423
24	Bcbs Nj facility · other · outpatient	2	$259	$259	—	—	—	$259 – $259
25	Medica facility · fee schedule · outpatient	2	$272	$272	—	—	—	$272 – $272

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