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South Dakota rates for HCPCS 89261

Sprm Isol Cplx Prep Insemination/Dx Semen Alys

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$90.98 / $90.98 / $90.98
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$81.51 / $90.98 / $292.50
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$167.12 / $167.12 / $167.12
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$106.79 / $167.12 / $208.90
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$130.10 / $176.72 / $417.90
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$160.93 / $160.93 / $160.93
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$148.80 / $148.80 / $148.80
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$134.00 / $134.00 / $134.00