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Maine 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 / $16,595.87
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,090.30 / $3,630.78 / $10,000.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16,218.10 / $16,595.87 / $16,595.87
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,897.79 / $16,595.87 / $16,595.87
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16,595.87 / $16,595.87 / $30,199.52
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16,595.87 / $16,595.87 / $19,952.62
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15,488.17 / $16,595.87 / $19,498.45
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10,715.19 / $16,218.10 / $23,442.29