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South Carolina 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
$15,848.93 / $15,848.93 / $15,848.93
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15,488.17 / $16,595.87 / $16,595.87
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$16,595.87 / $31,622.78 / $52,480.75
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
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$15,488.17 / $19,498.45 / $21,379.62
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.20 / $30.20 / $30.20
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,162.28 / $4,265.80 / $6,760.83
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16,218.10 / $16,218.10 / $17,378.01