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Massachusetts 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
$15,488.17 / $16,595.87 / $19,498.45
AllWays Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$10,964.78 / $11,748.98 / $58,884.37
AllWays Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,548.13 / $16,595.87 / $43,651.58
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$18,620.87 / $18,620.87 / $37,153.52
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
Fallon Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,995.26 / $4,466.84 / $8,511.38
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16,595.87 / $16,595.87 / $26,915.35
Mass General Brigham
Facility/Professional
Facility
Modifier
Low / Median / High Price
$10,964.78 / $11,748.98 / $58,884.37
Mass General Brigham
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,548.13 / $16,595.87 / $43,651.58
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,162.28 / $4,265.80 / $9,332.54
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16,218.10 / $16,595.87 / $21,877.62