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North Carolina 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
$16,608.54 / $16,608.54 / $16,608.54
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16,217.75 / $16,608.54 / $16,608.54
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$14,525.93 / $17,097.02 / $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 / $19,539.46
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,504.08 / $6,413.89 / $17,605.05
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,504.08 / $3,504.08 / $3,504.08
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16,282.88 / $16,282.88 / $21,167.74
Wellcare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$18,562.49 / $18,562.49 / $39,078.92
Wellcare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$74,249.95 / $74,249.95 / $87,927.57