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South Dakota rates for HCPCS A9540

Technetium Tc-99m macroaggregated albumin, diagnostic, per study dose, up to 10 mCi

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$36.31 / $776.25 / $2,187.76
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$28.18 / $33.11 / $251.19
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$33.11 / $33.11 / $41.69
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$32.36 / $46.77 / $89.13
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.20 / $30.20 / $33.88
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$37.15 / $37.15 / $37.15
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$25.70 / $25.70 / $25.70
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.20 / $30.20 / $33.88
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.20 / $30.20 / $30.20