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South Dakota rates for HCPCS A9607

Lutetium lu 177 vipivotide

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$298.07 / $298.07 / $47,102.46
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$242.54 / $278.92 / $298.07
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$135.25 / $169.06 / $388.35
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$253.36 / $253.36 / $253.36
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$292.22 / $404.96 / $493.85
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$243.52 / $248.39 / $1,037.82
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$388.35 / $566.84 / $581.32
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$260.31 / $260.31 / $260.31
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$253.36 / $253.36 / $253.36
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$248.39 / $248.39 / $273.23
Wellmark
Facility/Professional
Facility
Modifier
Low / Median / High Price
$243.52 / $243.52 / $243.52
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$243.52 / $243.52 / $243.52