go back

Wisconsin rates for HCPCS A9604

Samarium Sm-153 lexidronam, therapeutic, per treatment dose, up to 150 mCi

Facilitymedian $15,488 · 10th–90th $4,266–$35,4810%10%10th90th$15,488Professionalmedian $15,849 · 10th–90th $6,026–$16,5960%50%10th90th$15,849$50.0$200.0$1.0K$5.0K$20.0K$100.0K

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$15,488.17 / $15,488.17 / $15,488.17
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$15,488.17 / $15,848.93 / $16,595.87
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$5,888.44 / $6,760.83 / $7,079.46
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$3,715.35 / $16,218.10 / $16,218.10
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$5,495.41 / $11,481.54 / $25,703.96
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$4,365.16 / $6,918.31 / $16,595.87
DeanCare
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$7,943.28 / $31,622.78 / $43,651.58
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$3,630.78 / $7,943.28 / $19,498.45
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$16,218.10 / $16,218.10 / $33,884.42
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$32.36 / $54.95 / $85.11
Network Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$18,197.01 / $18,197.01 / $18,197.01
Network Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$6,165.95 / $6,165.95 / $6,165.95
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$5,888.44 / $8,709.64 / $12,302.69
Quartz
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$16,595.87 / $16,595.87 / $58,884.37
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$5,623.41 / $16,595.87 / $87,096.36
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$3,162.28 / $4,265.80 / $10,000.00
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$16,218.10 / $16,218.10 / $21,379.62