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South Dakota rates for HCPCS 80198

Theophylline

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$13.29 / $13.29 / $13.29
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9.47 / $13.29 / $13.29
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$28.07 / $28.07 / $28.07
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.52 / $26.11 / $32.64
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$13.54 / $22.69 / $85.10
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8.48 / $12.73 / $29.10
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$18.25 / $28.81 / $44.33
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$18.25 / $28.81 / $38.79
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$23.10 / $33.02 / $38.85
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.94 / $9.89 / $16.97
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$14.14 / $14.14 / $14.14