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South Dakota rates for HCPCS Q0510

Pharmacy supply fee for initial immunosuppressive drug(s), first month following transplant

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$52.67 / $52.67 / $52.67
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$18.75 / $19.13 / $23.44
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$52.67 / $85.03 / $144.32
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.00 / $80.00 / $105.00
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.05 / $60.05 / $60.05
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$52.24 / $89.25 / $105.00
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$35.79 / $35.79 / $35.79