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South Dakota rates for HCPCS A9504

Technetium Tc-99m Apcitide Diagnostic Per Study Dose Up To 20 Millicuries

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$500.00 / $500.00 / $500.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$415.00 / $425.00 / $500.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$475.13 / $475.13 / $593.91
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$572.00 / $760.50 / $1,233.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$500.00 / $500.00 / $550.00
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$622.79 / $730.02 / $1,208.58
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$730.02 / $763.70 / $1,221.27
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$500.00 / $500.00 / $550.00