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Minnesota 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 / $16,218.10 / $19,498.45
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,073.80 / $4,265.80 / $8,511.38
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$851.14 / $1,071.52 / $1,071.52
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7,413.10 / $12,302.69 / $14,125.38
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,265.80 / $5,370.32 / $5,754.40
Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$10,715.19 / $11,220.18 / $15,848.93
Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,168.69 / $4,168.69 / $5,754.40
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,265.80 / $19,498.45 / $29,512.09
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16,218.10 / $16,218.10 / $32,359.37
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,162.28 / $3,162.28 / $3,162.28
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16,218.10 / $16,218.10 / $29,512.09