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New Hampshire 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
$16,595.87 / $16,595.87 / $19,952.62
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13,489.63 / $16,595.87 / $16,595.87
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,466.84 / $12,302.69 / $33,884.42
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16,218.10 / $16,595.87 / $19,054.61
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
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16,595.87 / $16,595.87 / $31,622.78
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16,218.10 / $16,218.10 / $16,595.87