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South Dakota rates for HCPCS Q2017

Injection Teniposide 50 Mg (Special Coverage Instructions Apply. See Mcm: 2049)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,995.14 / $2,995.14 / $2,995.14
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,396.11 / $2,545.87 / $2,995.14
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$356.63 / $392.29 / $490.36
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$351.72 / $3,426.44 / $5,391.26
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,495.94 / $2,778.52 / $11,381.53
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$275.58 / $376.57 / $508.30
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$302.02 / $360.38 / $745.94
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,495.94 / $2,495.94 / $2,778.52