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South Dakota 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
$19,498.45 / $19,498.45 / $19,498.45
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15,488.17 / $16,595.87 / $19,498.45
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,168.69 / $4,265.80 / $5,248.07
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$16,982.44 / $25,118.86 / $47,863.01
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13,803.84 / $16,218.10 / $18,620.87
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6,025.60 / $6,025.60 / $6,025.60
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16,218.10 / $16,218.10 / $18,620.87
Wellmark
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,265.80 / $4,265.80 / $4,265.80
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,265.80 / $4,265.80 / $4,265.80