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South Dakota rates for HCPCS 49492

Rpr 1st Ingun Hrna Preterm Inft Incarcerated

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$865.19 / $865.19 / $4,338.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$784.39 / $865.19 / $938.28
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,506.06 / $2,071.63 / $2,589.53
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$938.17 / $1,462.17 / $2,480.69
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,054.05 / $1,826.26 / $7,251.24
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,422.17 / $2,141.91 / $2,997.10
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,353.00 / $2,117.16 / $2,582.14
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,048.71 / $1,460.00 / $1,881.83
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,143.00 / $3,143.00 / $3,143.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,004.44 / $1,660.41 / $2,582.86
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,866.90 / $2,284.10 / $2,284.10