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South Dakota rates for HCPCS A9510

Technetium Tc-99m Disofennin Diagnostic Per Study Dose Up To 15 Millicuries L Coverage Instructions Apply. See Mcm: 15030)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$84.00 / $84.00 / $84.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$69.72 / $71.40 / $84.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$59.25 / $71.40 / $74.06
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$86.20 / $127.76 / $207.14
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.80 / $79.80 / $87.78
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$88.26 / $104.54 / $142.04
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$89.76 / $104.54 / $169.39
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.80 / $79.80 / $87.78