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South Dakota rates for HCPCS 49496

Rpr 1st Ingun Hrna Full Term Inft <6 Mo Incarcer

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$559.35 / $559.35 / $559.35
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$507.62 / $559.35 / $602.72
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$977.61 / $1,344.73 / $1,680.91
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$605.12 / $945.30 / $1,576.06
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$647.75 / $1,079.58 / $5,178.08
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$843.58 / $1,487.55 / $3,960.15
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$859.00 / $1,321.30 / $1,659.31
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$676.19 / $929.68 / $1,213.58
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
$631.63 / $1,067.49 / $1,660.54
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,203.90 / $1,473.00 / $1,473.00