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South Dakota rates for HCPCS A9583

Injection, gadofosveset trisodium, 1 ml

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$17.86 / $17.86 / $17.86
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$17.86 / $17.86 / $44.18
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.13 / $19.13 / $23.91
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$21.01 / $63.18 / $121.05
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.01 / $21.01 / $23.11
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$25.36 / $25.36 / $25.36
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.08 / $22.28 / $25.36
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.01 / $21.01 / $23.11