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South Dakota rates for HCPCS A9582

Iodine I-123 iobenguane, diagnostic, per study dose, up to 15 mCi

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,130.09 / $6,130.09 / $6,130.09
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,210.58 / $6,130.09 / $6,130.09
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,542.13 / $3,177.66 / $3,177.66
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,130.09 / $9,323.87 / $15,116.80
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,108.41 / $5,108.41 / $5,823.59
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,788.82 / $3,646.86 / $6,571.19
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,788.82 / $3,695.02 / $6,100.85
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7,815.87 / $7,815.87 / $7,815.87
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,108.41 / $5,108.41 / $5,619.25
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7,662.62 / $7,662.62 / $7,662.62