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South Dakota rates for HCPCS 85290

Clotting; factor XIII (fibrin stabilizing)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$15.14 / $158.49 / $426.58
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.00 / $15.14 / $43.65
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$31.62 / $31.62 / $31.62
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.05 / $31.62 / $39.81
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$15.49 / $25.12 / $128.82
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9.77 / $11.48 / $22.91
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$26.92 / $39.81 / $44.67
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.92 / $11.48 / $28.18
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.22 / $16.22 / $16.22