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South Dakota rates for HCPCS C9250

Human Plasma Fibrin Sealant Vapor-Heated Solvent Detergent (Artiss) 2 Ml

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$220.67 / $220.67 / $220.67
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$187.57 / $220.67 / $220.67
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$64.48 / $75.40 / $216.55
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$187.57 / $187.57 / $187.57
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$259.14 / $305.81 / $372.93
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$790.40 / $790.40 / $790.40
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$216.55 / $316.08 / $844.50
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$246.04 / $246.04 / $246.04
Wellmark
Facility/Professional
Facility
Modifier
Low / Median / High Price
$241.22 / $241.22 / $241.22