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South Dakota rates for HCPCS A9581

Eovist IV SOLN 0.25 MOL/L

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$14.73 / $197.96 / $219.96
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$14.73 / $14.88 / $22.09
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.00 / $15.00 / $18.75
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$17.04 / $24.84 / $40.28
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$14.70 / $14.70 / $16.17
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$16.73 / $17.64 / $22.05
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.73 / $17.64 / $38.47
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.12 / $16.12 / $16.12
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$14.73 / $14.73 / $16.20
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$14.70 / $14.70 / $14.70