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South Dakota rates for HCPCS C9091

Sirolimus, Protein-Bound,1mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$81.42 / $81.42 / $81.42
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$69.20 / $81.42 / $81.42
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$69.20 / $69.20 / $69.20