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South Dakota rates for HCPCS A9507

Indium In-111 capromab pendetide, diagnostic, per study dose, up to 10 millicuries

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,265.80 / $5,248.07 / $5,248.07
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,265.80 / $4,466.84 / $7,244.36
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,905.46 / $1,905.46 / $2,398.83
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,884.03 / $6,760.83 / $12,882.50
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,995.26 / $5,248.07 / $5,248.07
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,995.26 / $1,995.26 / $1,995.26
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,248.07 / $5,248.07 / $5,754.40