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South Dakota rates for HCPCS A9568

Technetium tc-99m arcitumomab, diagnostic, per study dose, up to 45 millicuries

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,300.00 / $1,300.00 / $1,300.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,105.00 / $1,300.00 / $1,300.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,066.90 / $1,066.90 / $1,826.88
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,487.20 / $1,977.30 / $3,205.80
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,235.00 / $1,235.00 / $1,358.50
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,214.27 / $1,862.88 / $2,101.21
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,862.88 / $1,887.47 / $3,116.44
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,235.00 / $1,235.00 / $1,358.50
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$809.51 / $809.51 / $809.51