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New York 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
$13,482.23 / $15,631.60 / $16,608.54
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13,482.23 / $16,217.75 / $16,608.54
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,451.93 / $3,451.93 / $4,314.91
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16,282.88 / $16,282.88 / $16,282.88
CDPHP
Facility/Professional
Facility
Modifier
Low / Median / High Price
$16,282.88 / $16,282.88 / $16,282.88
CDPHP
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16,282.88 / $16,282.88 / $16,282.88
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$16,608.54 / $17,620.00 / $17,620.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16,608.54 / $16,608.54 / $16,608.54
Emblem Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$16,608.54 / $16,608.54 / $26,905.83
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$14,117.26 / $16,608.54 / $16,608.54
Excellus BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7,834.59 / $7,834.59 / $7,834.59
MVP Health Care
Facility/Professional
Facility
Modifier
Low / Median / High Price
$597.00 / $17,106.80 / $17,620.00
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16,608.54 / $16,608.54 / $16,608.54
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16,282.88 / $16,282.88 / $21,979.28
Univera
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7,834.59 / $7,834.59 / $7,834.59