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South Dakota rates for HCPCS 80170

Gentamicin

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$15.40 / $15.40 / $15.40
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.97 / $15.40 / $15.40
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$32.64 / $32.64 / $32.64
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.00 / $30.03 / $37.54
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$15.69 / $26.27 / $106.43
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9.83 / $14.74 / $32.96
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$21.15 / $33.36 / $51.35
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.15 / $36.00 / $46.96
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$26.16 / $38.25 / $45.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.88 / $14.74 / $18.84
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.38 / $16.38 / $16.38