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Louisiana 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
$19,498.45 / $19,498.45 / $19,498.45
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15,488.17 / $16,595.87 / $19,498.45
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$17,782.79 / $17,782.79 / $17,782.79
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$17,782.79 / $17,782.79 / $17,782.79
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
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,162.28 / $3,630.78 / $4,570.88
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16,218.10 / $16,218.10 / $19,498.45