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South Dakota rates for HCPCS A9502

Technetium Tc 99m Tetrofosmin Diagnostic Per Study Dose Up To 40 Millicuries (Special Coverage Instructions Apply. See Mcm: 15

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$102.33 / $582.79 / $1,850.76
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$84.93 / $93.42 / $341.74
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$128.25 / $128.25 / $160.31
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$102.33 / $155.65 / $779.98
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$85.27 / $85.27 / $97.21
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$167.67 / $167.76 / $374.71
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$167.67 / $169.89 / $280.50
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$99.41 / $99.41 / $99.41
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$85.27 / $85.27 / $93.80
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$97.46 / $97.46 / $97.46