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Maryland rates for HCPCS A9604

Samarium Sm-153 lexidronam, therapeutic, per treatment dose, up to 150 mCi

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15,488.17 / $16,595.87 / $19,498.45
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15,488.17 / $15,488.17 / $15,488.17
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
$3,801.89 / $15,848.93 / $18,620.87
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$16,218.10 / $18,620.87 / $19,498.45
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16,218.10 / $16,218.10 / $19,498.45
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6,456.54 / $6,456.54 / $6,456.54