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Tennessee 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
$16,217.75 / $16,217.75 / $28,381.10
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15,631.57 / $16,217.75 / $16,217.80
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$17,911.16 / $19,523.18 / $20,956.07
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
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$18,562.49 / $39,078.92 / $73,272.98
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$74,249.95 / $74,249.95 / $87,927.57
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16,282.88 / $16,282.88 / $16,282.88