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South Dakota rates for HCPCS Q9955

Injection, perflexane lipid microspheres, per ml

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$16.20 / $16.20 / $16.20
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.77 / $13.77 / $16.20
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.50 / $13.50 / $16.88
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$18.67 / $22.73 / $27.38
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.25 / $13.25 / $14.58
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$45.81 / $45.81 / $45.81
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$41.59 / $45.81 / $45.81
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.25 / $13.25 / $14.58