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South Dakota rates for HCPCS A9558

Xenon Xe-133 gas, diagnostic, per 10 mCi

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$245.47 / $309.03 / $309.03
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$245.47 / $257.04 / $416.87
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$323.59 / $323.59 / $398.11
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$42.66 / $398.11 / $758.58
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$218.78 / $257.04 / $288.40
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$102.33 / $102.33 / $102.33
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$269.15 / $269.15 / $269.15
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$263.03 / $263.03 / $288.40
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$257.04 / $257.04 / $257.04