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South Dakota rates for HCPCS 86759

Antibody Rotavirus

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$17.14 / $17.14 / $17.14
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.21 / $17.14 / $17.14
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$36.56 / $36.56 / $36.56
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20.65 / $32.64 / $40.79
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$17.46 / $21.16 / $116.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9.23 / $16.41 / $27.14
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$13.02 / $33.42 / $47.30
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.02 / $29.00 / $47.58
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.71 / $42.57 / $50.08
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.66 / $10.94 / $21.88
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$18.23 / $18.23 / $18.23