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South Dakota rates for HCPCS A9501

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$77.62 / $77.62 / $77.62
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$77.62 / $77.62 / $151.36
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$112.20 / $213.80 / $407.38