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Alaska 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
$26,378.27 / $26,378.27 / $26,378.27
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16,608.54 / $16,608.54 / $16,608.54
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$37,720.93 / $37,720.93 / $37,720.93
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,680.78 / $3,680.78 / $5,258.25
Premera BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$27,355.24 / $27,355.24 / $42,986.81
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$27,355.24 / $37,720.93 / $64,480.22
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,680.78 / $5,258.25 / $16,608.54
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16,282.88 / $24,424.32 / $32,845.83