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South Dakota rates for HCPCS 84081

Phosphatidylglycerol

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$15.53 / $15.53 / $15.53
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.07 / $15.53 / $15.53
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$32.64 / $32.64 / $32.64
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.00 / $30.03 / $37.54
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$15.83 / $26.49 / $100.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9.91 / $14.87 / $33.99
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$21.31 / $33.65 / $51.79
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.31 / $36.71 / $47.33
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$26.98 / $38.58 / $45.38
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.94 / $14.87 / $21.81
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.52 / $16.52 / $16.52