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Utah 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
$16,218.10 / $16,218.10 / $16,218.10
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15,488.17 / $16,218.10 / $19,498.45
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
$44.67 / $44.67 / $14,125.38
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$28,183.83 / $35,481.34 / $64,565.42
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$18,620.87 / $18,620.87 / $24,547.09
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16,595.87 / $19,498.45 / $22,387.21
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10,964.78 / $10,964.78 / $10,964.78
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16,218.10 / $16,218.10 / $16,218.10