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North Dakota 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
$15,631.57 / $15,631.57 / $15,631.57
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15,631.57 / $16,217.75 / $19,539.46
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$17,097.02 / $17,182.50 / $17,403.06
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$14,532.47 / $17,156.86 / $17,403.06
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,201.13 / $5,251.41 / $16,608.54
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$15,631.57 / $20,321.04 / $27,843.74
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16,282.88 / $16,282.88 / $74,249.95
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16,282.88 / $16,282.88 / $17,911.16