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South Dakota rates for HCPCS A9584

Iodine I-123 ioflupane, diagnostic, per study dose, up to 5 mCi

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,110.40 / $4,853.29 / $5,243.57
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,581.63 / $2,643.84 / $3,110.40
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,714.63 / $2,714.63 / $3,393.28
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,961.60 / $4,454.66 / $7,303.31
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,468.00 / $2,592.00 / $2,851.20
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,880.77 / $2,880.77 / $3,360.89
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,964.04 / $2,964.04 / $2,964.04
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,643.84 / $2,643.84 / $2,643.84
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,592.00 / $2,592.00 / $2,851.20
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,468.00 / $2,468.00 / $2,468.00