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Indiana 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
$15,631.57 / $39,078.90 / $39,078.90
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15,631.57 / $15,631.57 / $15,631.57
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,314.91 / $19,201.50 / $37,450.62
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,401.17 / $5,401.17 / $9,055.76
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,946.55 / $4,291.89 / $30,275.33
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,301.46 / $4,126.83 / $4,952.18
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$16,608.54 / $16,608.54 / $16,608.54
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16,608.54 / $16,608.54 / $19,539.46
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16,282.88 / $16,282.88 / $20,190.77