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Ohio 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
$15,488.17 / $15,488.17 / $28,840.32
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15,488.17 / $16,218.10 / $19,498.45
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,388.44 / $7,943.28 / $104,712.85
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9,120.11 / $11,748.98 / $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 / $19,498.45
Medical Mutual of Ohio
Facility/Professional
Facility
Modifier
Low / Median / High Price
$16,595.87 / $16,595.87 / $16,595.87
Medical Mutual of Ohio
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16,595.87 / $16,595.87 / $19,498.45
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$39.81 / $50.12 / $60.26
SummaCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,801.89 / $3,801.89 / $3,801.89
SummaCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$17,378.01 / $21,379.62 / $37,153.52
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,162.28 / $3,162.28 / $4,265.80
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16,218.10 / $16,218.10 / $17,782.79