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South Dakota rates for HCPCS Q9965

Low osmolar contrast material, 100-199 mg/ml iodine concentration, per ml

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.96 / $42.75 / $199.32
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.96 / $0.96 / $1.06
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.94 / $0.96 / $1.17
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.47 / $3.04 / $3.14
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.53 / $1.80 / $527.24
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.12 / $1.57 / $2.16
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.03 / $1.37 / $2.16
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.04 / $1.04 / $1.04
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.96 / $0.96 / $1.20
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.80 / $1.80 / $1.80