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Wyoming rates for HCPCS A9604

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

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15,631.57 / $15,631.57 / $15,631.57
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16,608.54 / $19,539.46 / $19,539.46
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16,608.54 / $16,608.54 / $16,608.54
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16,282.88 / $16,282.88 / $16,282.88