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South Dakota rates for HCPCS A9554

Iodine I-125 Sodium Iothalamate M Diagnostic Per Study Dose Up To 10 Microcuries

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$45.00 / $45.00 / $45.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$38.25 / $45.00 / $45.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$34.88 / $38.25 / $43.59
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$45.00 / $57.92 / $110.97
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$37.50 / $37.50 / $42.75
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$46.63 / $63.71 / $174.74
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$58.23 / $174.74 / $335.15
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$37.50 / $37.50 / $45.70