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South Dakota rates for HCPCS A9557

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,399.59 / $4,399.59 / $4,399.59
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,739.65 / $4,399.59 / $4,399.59
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$617.13 / $620.35 / $3,739.65
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$601.17 / $5,662.27 / $10,849.39
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,666.33 / $3,666.33 / $4,179.60
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$513.29 / $660.96 / $3,379.89
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$536.25 / $640.92 / $1,058.25
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,666.33 / $3,666.33 / $4,032.96
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$683.80 / $683.80 / $683.80