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South Dakota rates for HCPCS A9547

Indium In-111 oxyquinoline, diagnostic, per 0.5 mCi

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,525.98 / $2,525.98 / $2,525.98
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,096.56 / $2,147.08 / $2,525.98
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,575.88 / $2,575.88 / $3,219.84
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,525.98 / $3,250.93 / $6,229.06
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,104.98 / $2,104.98 / $2,399.67
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$380.50 / $497.56 / $1,158.96
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$380.50 / $504.13 / $832.38
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,147.08 / $2,147.08 / $2,147.08
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,104.98 / $2,104.98 / $2,315.48
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,104.98 / $2,104.98 / $2,104.98