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South Dakota rates for HCPCS 79403

Radiopharmaceutical therapy, radiolabeled monoclonal antibody by intravenous infusion

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$177.83 / $204.17 / $295.12
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$371.54 / $407.38 / $512.86
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$165.96 / $251.19 / $436.52
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$436.52 / $436.52 / $436.52
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$245.47 / $316.23 / $338.84
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$229.09 / $288.40 / $407.38
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$288.40 / $338.84 / $338.84