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Montana 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
Facility
Modifier
Low / Median / High Price
$5,820.61 / $9,676.92 / $24,659.07
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,820.61 / $16,608.54 / $16,608.54
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,820.61 / $9,676.92 / $24,659.07
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,880.04 / $5,968.94 / $22,274.99
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16,282.88 / $16,282.88 / $16,282.88