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South Dakota rates for HCPCS 81316

Pml/Raralpha Single Breakpoint Qual/Quan

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$194.87 / $194.87 / $194.87
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$138.90 / $161.69 / $194.87
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$413.22 / $413.22 / $413.22
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$297.88 / $376.67 / $470.83
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$195.65 / $234.74 / $506.95
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$124.39 / $221.22 / $650.64
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$267.52 / $454.33 / $702.69
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$248.77 / $422.37 / $855.69
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$352.43 / $516.37 / $860.62
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$87.07 / $186.58 / $221.22
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$207.31 / $207.31 / $207.31