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South Dakota rates for HCPCS Q2050

Injection, doxorubicin HCl, liposomal, not otherwise specified, 10 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$104.71 / $208.93 / $1,148.15
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$104.71 / $104.71 / $177.83
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$107.15 / $107.15 / $131.83
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$109.65 / $165.96 / $302.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$109.65 / $123.03 / $1,698.24
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$131.83 / $177.83 / $181.97
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$380.19 / $380.19 / $380.19
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$114.82 / $114.82 / $114.82
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$104.71 / $114.82 / $134.90
Wellmark
Facility/Professional
Facility
Modifier
Low / Median / High Price
$117.49 / $117.49 / $117.49
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$117.49 / $117.49 / $117.49