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South Dakota rates for HCPCS 80377

Drug/Substance Definitive Qual/Quant Nos 7/More

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$148.00 / $148.00 / $148.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$14.36 / $14.36 / $14.36
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.04 / $14.36 / $17.95
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$18.85 / $44.58 / $112.04
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.27 / $21.76 / $36.08
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
$25.00 / $25.00 / $25.00