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Missouri 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
$15,631.57 / $19,539.50 / $20,516.40
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15,631.57 / $15,631.57 / $16,217.75
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,314.91 / $15,499.16 / $42,856.54
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$14,654.60 / $14,654.60 / $19,539.46
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$16,608.54 / $16,608.54 / $16,608.54
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16,608.54 / $16,608.54 / $16,608.54
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,859.53 / $19,539.46 / $73,272.98
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$14,110.90 / $16,282.88 / $20,304.75
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16,282.88 / $16,282.88 / $19,148.66