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Kentucky 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 / $15,631.57 / $15,631.57
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15,631.57 / $15,631.57 / $16,217.75
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$10,787.28 / $19,201.50 / $19,213.80
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,401.17 / $7,697.40 / $9,055.76
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,396.45 / $4,396.45 / $4,396.45
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,069.66 / $4,110.68 / $31,396.64
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
$3,456.20 / $16,608.54 / $24,815.11
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$45.00 / $45.00 / $45.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16,282.88 / $16,282.88 / $16,282.88