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Connecticut rates for HCPCS A9604

Samarium Sm-153 lexidronam, therapeutic, per treatment dose, up to 150 mCi

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$16,595.87 / $16,595.87 / $16,595.87
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13,803.84 / $16,218.10 / $16,595.87
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$17,782.79 / $25,703.96 / $41,686.94
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16,218.10 / $16,218.10 / $16,218.10
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$16,595.87 / $16,595.87 / $16,595.87
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16,595.87 / $16,595.87 / $16,595.87
ConnectiCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16,595.87 / $16,595.87 / $16,595.87
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15,488.17 / $16,218.10 / $17,782.79