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South Dakota rates for HCPCS 79005

Radiopharmaceutical therapy, by oral administration

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$85.11 / $85.11 / $85.11
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$138.04 / $141.25 / $338.84
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$295.12 / $316.23 / $398.11
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$128.82 / $177.83 / $316.23
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$316.23 / $316.23 / $316.23
Midlands
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$204.17 / $204.17 / $204.17
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$177.83 / $229.09 / $263.03
Sanford Health Plan
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$112.20 / $144.54 / $162.18
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$158.49 / $213.80 / $302.00
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$229.09 / $269.15 / $269.15