A9513

Lutetium lu 177, dotatate, therapeutic, 1 millicurie

Medicare pricing data for 87 providers across 6 states

🤖AI Overview

Note: These costs reflect the Medicare physician/supplier component. Hospital facility fees are billed separately and can be 2-5x the physician fee.

💡 What You Should Know

Lutetium lu 177, dotatate, therapeutic, 1 millicurie (HCPCS code A9513) is a medical procedure billed to Medicare. The average Medicare-allowed cost is $302.22, but hospitals typically charge $544.33 — a 1.8x markup. Prices vary significantly by state and provider.

🏷️ Typical Out-of-Pocket Cost

$60.44

Medicare patients typically pay about 20% of the allowed amount as coinsurance. Based on the average allowed cost of $302.22, your out-of-pocket cost would be approximately $60.44. Actual costs depend on your specific plan, deductible, and whether you've met your annual out-of-pocket maximum.

Average Allowed Cost
$302.22
Average Hospital Charge
$544.33
Markup Ratio
1.8x

What Hospitals Charge vs. What Medicare Pays

Hospital Charge$544.33
Medicare Allowed$302.22
Medicare Payment$240.77

Hospitals charge 1.8x more than what Medicare allows for this procedure. Medicare actually pays $240.77 on average.

Cost by State

Medicare-allowed amounts vary significantly by state

StateAllowed CostHospital ChargeProvidersServicesvs. National
Washington$311$43166,000+2.9%
Arkansas$307$567105,599+1.6%
Texas$307$5941016,100+1.5%
Maryland$304$37436,200+0.6%
California$301$35536,164-0.3%
Florida$296$6131610,196-1.9%

⚠️ Important: These costs reflect the Medicare physician/supplier component. Hospital facility fees may be billed separately. Total out-of-pocket costs may be higher.

Related from TheDataProject.ai

💊 Need post-procedure medications? Check costs on OpenPrescriber