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South Dakota rates for HCPCS 80195

Sirolimus

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12.02 / $81.28 / $199.53
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8.91 / $12.02 / $37.15
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$26.30 / $26.30 / $26.30
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.85 / $26.30 / $32.36
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12.88 / $20.89 / $83.18
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8.32 / $9.55 / $19.05
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$22.39 / $33.11 / $38.02
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.75 / $9.55 / $23.99
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.80 / $13.80 / $13.80