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South Dakota rates for HCPCS 85415

Fibrinolytic factors and inhibitors; plasminogen activator

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$15.85 / $19.50 / $162.18
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.02 / $15.49 / $46.77
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$33.11 / $33.11 / $33.11
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.95 / $33.11 / $41.69
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8.32 / $19.50 / $54.95
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.23 / $12.02 / $23.99
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$28.18 / $41.69 / $46.77
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.24 / $12.02 / $29.51
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$17.38 / $17.38 / $17.38