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Oklahoma 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
$15,826.96 / $15,826.96 / $15,826.96
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15,631.57 / $15,826.96 / $16,217.75
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 / $16,608.54
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,314.91 / $16,601.06 / $22,632.55
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16,282.88 / $16,282.88 / $19,962.81
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16,282.88 / $16,282.88 / $17,259.84