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Virginia 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
$16,608.54 / $16,608.54 / $16,608.54
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16,217.75 / $16,608.54 / $16,608.54
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,314.91 / $9,104.45 / $14,670.69
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15,631.57 / $15,631.57 / $19,220.57
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15,631.57 / $15,631.57 / $15,631.57
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
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,353.63 / $5,121.92 / $18,562.49
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$16,608.54 / $19,539.46 / $27,404.09
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,570.70 / $6,709.00 / $8,702.33
Sentara
Facility/Professional
Facility
Modifier
Low / Median / High Price
$15,468.74 / $18,562.49 / $23,935.83
Sentara
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15,468.74 / $18,562.49 / $23,935.83
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16,282.88 / $16,282.88 / $19,539.46