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New Jersey 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
$15,631.57 / $16,217.75 / $16,608.54
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$16,608.54 / $16,608.54 / $21,493.41
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16,608.54 / $16,608.54 / $16,608.54
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16,608.54 / $16,608.54 / $16,608.54
Horizon BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7,188.64 / $8,707.49 / $9,350.41
Horizon BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16,608.54 / $16,608.54 / $16,608.54
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$18,273.74 / $18,273.74 / $18,273.74
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16,282.88 / $16,282.88 / $17,279.56