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South Dakota rates for HCPCS A9558

Xenon Xe-133 Gas Diagnostic Per 10 Millicuries

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$306.12 / $306.12 / $306.12
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$254.08 / $260.20 / $306.12
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$321.00 / $321.00 / $401.25
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$43.08 / $393.98 / $754.90
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$255.10 / $255.10 / $290.81
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$103.42 / $261.02 / $615.80
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$103.42 / $261.02 / $571.02
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$260.20 / $260.20 / $260.20
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$255.10 / $255.10 / $280.61
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$255.10 / $255.10 / $255.10