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South Dakota rates for HCPCS A9516

Iodine I-123 sodium iodide, diagnostic, per 100 mcCi, up to 999 mcCi

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$127.48 / $411.48 / $835.85
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$105.81 / $121.68 / $127.48
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$162.00 / $162.00 / $202.50
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$37.69 / $193.89 / $292.20
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$106.24 / $106.24 / $117.09
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$136.13 / $169.31 / $346.34
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$167.40 / $186.00 / $346.34
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$108.36 / $108.36 / $108.36
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$106.24 / $106.24 / $116.86
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$114.73 / $114.73 / $114.73