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South Dakota rates for HCPCS Q9966

Low osmolar contrast material, 200-299 mg/ml iodine concentration, per ml

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.45 / $27.38 / $54.30
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.45 / $0.45 / $0.67
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.41 / $0.42 / $0.52
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.41 / $0.76 / $1.23
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.45 / $0.45 / $11,271.93
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.40 / $0.53 / $0.61
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.27 / $0.49 / $0.57
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.49 / $0.49 / $0.49
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.45 / $0.45 / $0.50
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.45 / $0.45 / $0.45