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South Dakota rates for HCPCS 61517

Impltj Brain Intracavitary Chemotherapy Agent

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$76.73 / $76.73 / $76.73
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$93.91 / $129.69 / $225.08
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$125.13 / $200.33 / $269.04
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$102.37 / $149.79 / $170.78
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,000.00 / $2,000.00 / $2,000.00