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South Dakota rates for HCPCS A9596

Gallium Ga-68 gozetotide, diagnostic, (Illuccix), 1 mCi

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,230.27 / $6,918.31 / $7,413.10
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,000.00 / $1,023.29 / $6,456.54
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$645.65 / $1,737.80 / $2,137.96
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,288.25 / $1,288.25 / $1,621.81
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,122.02 / $1,584.89 / $2,089.30
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,023.29 / $1,023.29 / $4,466.84
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$645.65 / $776.25 / $1,479.11
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,096.48 / $1,096.48 / $1,096.48
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,096.48 / $1,096.48 / $1,258.93
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,023.29 / $1,023.29 / $1,023.29