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South Dakota rates for HCPCS Q9963

High osmolar contrast material, 350-399 mg/ml iodine concentration, per ml

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.69 / $38.90 / $38.90
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.00 / $1.00 / $1.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.23 / $0.23 / $0.28
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.22 / $0.37 / $0.58
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.22 / $0.22 / $0.26
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.26 / $0.26 / $0.28
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.22 / $0.22 / $0.22
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.24 / $0.24 / $0.24
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.22 / $0.22 / $0.23
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.22 / $0.22 / $0.22