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Mississippi 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
$15,848.93 / $15,848.93 / $23,442.29
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15,488.17 / $16,218.10 / $23,442.29
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,623.41 / $5,888.44 / $5,888.44
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8,128.31 / $8,128.31 / $8,128.31
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
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$42.66 / $42.66 / $50.12
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,162.28 / $4,265.80 / $4,570.88
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15,488.17 / $16,218.10 / $25,118.86