go back

South Dakota rates for HCPCS A9500

Technetium Tc-99m sestamibi, diagnostic, per study dose

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$150.07 / $747.12 / $1,367.10
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$106.31 / $108.89 / $230.58
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$147.38 / $147.38 / $184.22
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$164.86 / $315.89 / $590.41
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$175.84 / $450.58 / $495.64
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$141.97 / $175.84 / $277.19
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$141.97 / $175.84 / $294.17
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$173.85 / $173.85 / $173.85
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$450.58 / $450.58 / $495.64
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$250.00 / $250.00 / $250.00