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Idaho 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
$16,608.50 / $16,608.50 / $16,608.50
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15,631.57 / $16,608.54 / $16,803.93
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
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,076.31 / $16,803.93 / $24,029.63
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $14,200.30 / $36,196.86
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$17,259.84 / $25,889.78 / $44,012.62
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$18,562.49 / $22,274.99 / $23,203.11
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16,282.88 / $16,282.88 / $22,796.03