go back

Georgia 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
$16,218.10 / $16,218.10 / $16,218.10
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15,488.17 / $16,218.10 / $16,595.87
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,162.28 / $16,218.10 / $89,125.09
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,981.07 / $17,782.79 / $18,620.87
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
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15,488.17 / $16,595.87 / $41,686.94
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,265.80 / $8,511.38 / $11,748.98
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16,218.10 / $16,218.10 / $20,417.38