go back

New Mexico 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
$18,620.87 / $18,620.87 / $18,620.87
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15,488.17 / $16,218.10 / $19,498.45
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$19,054.61 / $41,686.94 / $66,069.34
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$16,595.87 / $16,595.87 / $16,595.87
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16,595.87 / $16,595.87 / $16,595.87
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.26 / $70.79 / $7,762.47
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$15,848.93 / $16,595.87 / $33,113.11
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16,595.87 / $16,595.87 / $16,595.87
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,162.28 / $3,162.28 / $18,620.87
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16,218.10 / $16,218.10 / $16,218.10