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South Dakota rates for HCPCS A9602

Fluorodopa F-18, diagnostic, per mCi

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$598.64 / $598.64 / $598.64
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$508.84 / $598.64 / $598.64
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$279.60 / $349.50 / $802.78
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$508.84 / $508.84 / $508.84
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$598.64 / $829.59 / $1,011.70
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$498.87 / $498.87 / $2,274.83
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$782.04 / $873.12 / $1,201.67
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$599.14 / $599.14 / $599.14
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$508.84 / $508.84 / $508.84
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$498.87 / $498.87 / $548.76
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$498.87 / $498.87 / $498.87