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South Dakota rates for HCPCS Q2009

Injection, fosphenytoin, 50 mg phenytoin equivalent

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.00 / $2.88 / $25.12
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.00 / $2.00 / $3.89
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.51 / $1.51 / $1.86
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.04 / $4.27 / $8.13
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.34 / $2.57 / $2.75
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.37 / $4.37 / $4.37
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.69 / $2.69 / $2.69
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.04 / $2.40 / $3.55
Wellmark
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.51 / $2.51 / $2.51