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Hawaii 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
$16,217.75 / $16,217.75 / $16,217.75
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16,608.54 / $16,608.54 / $25,059.36
HMSA
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,290.00 / $4,290.00 / $4,492.14
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20,418.74 / $22,274.99 / $23,203.11
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16,282.88 / $24,424.32 / $25,059.36