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South Dakota rates for HCPCS 80186

Phenytoin; free

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12.93 / $12.93 / $12.93
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9.22 / $12.93 / $12.93
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$27.42 / $27.42 / $27.42
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.11 / $25.46 / $31.82
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$13.18 / $22.06 / $81.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8.26 / $12.38 / $27.57
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$17.75 / $28.04 / $43.14
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$17.75 / $30.15 / $39.44
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.88 / $32.13 / $37.79
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.78 / $12.38 / $16.51
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.76 / $13.76 / $13.76