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West 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
$16,608.54 / $16,608.54 / $16,608.54
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 / $24,815.11
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16,282.88 / $16,282.88 / $23,582.50