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South Dakota rates for HCPCS Q9967

Low osmolar contrast material, 300-399 mg/ml iodine concentration, per ml

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$41.50 / $331.50 / $1,284.78
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.14 / $11.25 / $66.75
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.15 / $0.15 / $0.19
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.24 / $1.35 / $6.37
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.14 / $0.15 / $1,506.04
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.15 / $0.18 / $0.22
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.15 / $0.18 / $0.21
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.16 / $0.16 / $0.16
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.15 / $0.15 / $0.17
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.15 / $0.15 / $0.15