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South Dakota rates for HCPCS A9539

Technetium Tc-99m pentetate, diagnostic, per study dose, up to 25 mCi

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$37.60 / $37.60 / $37.60
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$31.96 / $37.60 / $37.60
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$31.96 / $31.96 / $78.47
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$43.01 / $57.19 / $92.72
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$35.72 / $37.60 / $41.36
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$37.85 / $44.63 / $59.90
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$37.85 / $44.63 / $133.87
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$31.96 / $37.60 / $41.36