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South Dakota rates for HCPCS A9520

Technetium Tc-99m Tilmanocept Diagnostic Up To 0.5 Millicuries (Code Was Deleted 12/31/05 But Reinstated On 1/1/14) Supply Of Radiopharmaceutical Diagnostic Imaging Aagent Technitium Tc-99m Sulfur Colloid Per Mci

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$347.50 / $815.95 / $1,193.58
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$658.93 / $757.76 / $793.89
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$231.00 / $233.31 / $288.75
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$569.98 / $835.89 / $1,207.51
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$661.57 / $661.57 / $754.20
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$564.22 / $564.22 / $564.22
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$479.20 / $479.20 / $479.20
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$661.57 / $661.57 / $727.73
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$469.80 / $469.80 / $469.80