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South Dakota rates for HCPCS C2615

Sealant, pulmonary, liquid

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$239.88 / $239.88 / $239.88
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$239.88 / $239.88 / $1,122.02
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$338.84 / $407.38 / $2,238.72