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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
$36.00 / $36.00 / $781.79
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.60 / $32.86 / $36.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$33.00 / $33.00 / $41.25
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$32.22 / $46.33 / $88.78
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $30.00 / $34.20
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$37.56 / $40.79 / $69.86
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$37.56 / $40.79 / $89.26
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$25.50 / $25.50 / $25.50
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $30.00 / $33.00
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $30.00 / $30.00