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South Dakota rates for HCPCS Q9957

Injection, perflutren lipid microspheres, per ml

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$40.65 / $493.48 / $984.17
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$40.65 / $45.16 / $92.30
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$42.68 / $43.10 / $53.34
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$41.20 / $69.63 / $120.22
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$41.20 / $41.20 / $1,627.92
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$49.44 / $57.85 / $64.81
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$49.44 / $54.99 / $67.65
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$44.49 / $44.49 / $44.49
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$40.65 / $40.65 / $44.72
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$41.20 / $41.20 / $41.20