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South Dakota rates for HCPCS 80335

Antidepressants Tricyclic Other Cyclicals 1 Or 2

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$103.00 / $103.00 / $103.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$31.99 / $31.99 / $31.99
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20.23 / $31.99 / $39.97
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$17.92 / $42.39 / $112.04
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.63 / $21.76 / $37.14
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$35.17 / $40.27 / $44.10
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$35.17 / $40.27 / $62.85
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.07 / $14.51 / $28.73
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$25.10 / $25.10 / $25.10