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South Dakota rates for HCPCS 96405

Chemotherapy Administration Intralesional </7

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$28.42 / $28.42 / $85.40
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$29.76 / $82.27 / $135.65
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$199.20 / $199.20 / $199.20
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$49.43 / $74.75 / $217.22
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$34.03 / $82.27 / $182.60
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$90.48 / $155.69 / $586.42
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$60.52 / $155.69 / $210.76
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$57.95 / $130.00 / $196.62
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$47.29 / $105.10 / $159.13
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$85.93 / $141.34 / $165.78
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$63.80 / $66.30 / $189.80