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South Dakota rates for HCPCS A9507

Indium In 111 Capromab Pendetide Diagnostic Per Study Dose Up To 10 Millicuries Special Coverage Instructions Apply. See Mcm: 1502

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,275.21 / $5,275.21 / $5,275.21
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,378.42 / $4,483.93 / $5,275.21
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,903.13 / $1,922.16 / $2,378.91
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,878.50 / $8,023.60 / $13,008.67
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,001.72 / $5,275.21 / $5,802.73
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,257.66 / $1,855.00 / $3,118.21
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,718.39 / $2,001.72 / $2,614.65
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,275.21 / $5,275.21 / $5,802.73