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Montana rates for HCPCS A9604

Samarium Sm-153 lexidronam, therapeutic, per treatment dose, up to 150 mCi

Facilitymedian $6,457 · 10th–90th $6,310–$24,5470%50%10th90th$6,457Professionalmedian $16,218 · 10th–90th $6,457–$16,5960%20%40%10th90th$16,218$100.0$500.0$2.0K$10.0K$50.0K

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$15,488.17 / $16,218.10 / $16,595.87
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$5,754.40 / $9,772.37 / $24,547.09
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$5,754.40 / $16,595.87 / $16,595.87
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$6,309.57 / $6,456.54 / $6,456.54
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$6,309.57 / $6,456.54 / $6,456.54
Providence
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$5,754.40 / $9,772.37 / $24,547.09
Providence
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$79.43 / $3,890.45 / $16,595.87
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$16,218.10 / $16,218.10 / $16,218.10