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Arizona 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
$15,826.96 / $15,826.96 / $15,826.96
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8,397.67 / $31,891.83 / $50,521.13
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11,137.49 / $14,849.99 / $71,929.64
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
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$15,826.96 / $19,539.46 / $73,272.98
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16,282.88 / $16,282.88 / $38,427.60
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16,282.88 / $16,282.88 / $16,282.88