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.
Original text from hospital filings
LUTETIUM LU 177 DOTATATE 10 MCI/ML (370 MBQ/ML) INTRAVENOUS SOLUTION
Low
$269
Average
$452
Median
$313
High
$1.1k
Each hospital's average Tricare rate, under the methodology and billing class chosen below.
55 hospitals; the 90th percentile is 3.7× the 10th. Each bar is a price range and its height is how many hospitals fall in it. Hover a bar, or a row in the ladder, for details.
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56 hospital rates
iThe hospitals that file a Tricare rate for this code, one row per hospital and set of terms (billing class, payment method, setting). Rates under different terms are never blended, so the terms are shown under each hospital’s name. Figures are the hospital’s averages across its plans.| # | Plans | |||||||
|---|---|---|---|---|---|---|---|---|
| 1 | Beaufort Memorial Hospital Beaufort, SC facility · fee schedule · outpatient | 1 | $296 | $296 | — | — | — | $296 – $296 |
| 2 | Boston Medical Center Boston, MA other · both | 1 | $297 | $297 | — | — | — | $297 – $297 |
| 3 | Butler Healthcare Providers_ DBA Butler Memorial Hospital Butler, PA facility · fee schedule · outpatient | 1 | $317 | $317 | — | — | — | $317 – $317 |
| 4 | CLAIBORNE MEDICAL CENTER Tazewell, TN fee schedule · outpatient | 1 | $301 | $301 | — | — | — | $301 – $301 |
| 5 | CUMBERLAND MEDICAL CENTER, INC. Crossville, TN fee schedule · outpatient | 1 | $301 | $301 | — | — | — | $301 – $301 |
| 6 | CentraState Medical Center Freehold Township, NJ other · outpatient | 2 | $313 | $313 | — | — | — | $313 – $313 |
| 7 | Charleston Area Medical Center Charleston, WV percent of total billed charges · bothfrom % of charges | 1 | $287 | $287 | — | — | — | $287 – $287 |
| 8 | Chilton Medical Center Pompton Plains, NJ other · outpatient | 2 | $313 | $313 | — | — | — | $313 – $313 |
| 9 | Clarion Hospital Clarion, PA facility · fee schedule · outpatient | 1 | $317 | $317 | — | — | — | $317 – $317 |
| 10 | FORT LOUDOUN MEDICAL CENTER Lenoir City, TN fee schedule · outpatient | 1 | $282 | $282 | — | — | — | $282 – $282 |
| 11 | FORT SANDERS REGIONAL MEDICAL CENTER Knoxville, TN fee schedule · outpatient | 1 | $282 | $282 | — | — | — | $282 – $282 |
| 12 | Hackettstown Medical Center Hackettstown, NJ other · outpatient | 2 | $313 | $313 | — | — | — | $313 – $313 |
| 13 | IHC Health Services Inc., DBA Intermountain Primary Children's Hospital City, UT facility · fee schedule · outpatient | 1 | $296 | $296 | — | — | — | $296 – $296 |
| 14 | IHC Health Services Inc., DBA Intermountain Primary Children's Hospital Lehi, UT facility · fee schedule · outpatient | 1 | $296 | $296 | — | — | — | $296 – $296 |
| 15 | KARMANOS CANCER CENTER DETROIT, MI fee schedule | 1 | $280 | $280 | — | — | — | $280 – $280 |
| 16 | Kaleida Health Buffalo, NY fee schedule · outpatient | 1 | $304 | $304 | — | — | — | $304 – $304 |
| 17 | LECONTE MEDICAL CENTER Sevierville, TN fee schedule · outpatient | 1 | $301 | $301 | — | — | — | $301 – $301 |
| 18 | Little Company of Mary Hospital of Indiana Inc Jasper, IN facility · case rate · outpatient | 1 | $269 | $269 | — | — | — | $269 – $269 |
| 19 | METHODIST MEDICAL CENTER OF OAK RIDGE Oak Ridge, TN fee schedule · outpatient | 1 | $282 | $282 | — | — | — | $282 – $282 |
| 20 | MORRISTOWN HAMBLEN HOSPITAL ASSOCIATION Morristown, TN fee schedule · outpatient | 1 | $282 | $282 | — | — | — | $282 – $282 |
| 21 | MedStar Franklin Square Medical Center Baltimore, MD percent of total billed charges · outpatientfrom % of charges | 1 | $306 | $306 | — | — | — | $306 – $306 |
| 22 | MedStar Georgetown Hospital Washington, DC facility · fee schedule · outpatient | 1 | $321 | $321 | — | — | — | $321 – $321 |
| 23 | MedStar Good Samaritan Hospital Baltimore, MD percent of total billed charges · outpatientfrom % of charges | 1 | $883 | $883 | — | — | — | $883 – $883 |
| 24 | MedStar Harbor Hospital Baltimore, MD percent of total billed charges · outpatientfrom % of charges | 1 | $724 | $724 | — | — | — | $724 – $724 |
| 25 | MedStar Montgomery Medical Center Olney, MD percent of total billed charges · outpatientfrom % of charges | 1 | $400 | $400 | — | — | — | $400 – $400 |
← Payers reporting HCPCS A9513 · Snapshot 20261111T120946Z-9134e7f7