go back

South Dakota rates for HCPCS Q4155

Neox Flo or Clarix Flo 1 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$26.62 / $26.62 / $26.62
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$26.62 / $26.62 / $26.62
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$26.81 / $26.81 / $33.52
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$38.40 / $46.15 / $74.83
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$23.21 / $27.31 / $27.31
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$31.57 / $31.57 / $32.77
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$22.42 / $32.74 / $43.08
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$29.14 / $29.14 / $29.14
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$26.62 / $26.62 / $26.62
Wellmark
Facility/Professional
Facility
Modifier
Low / Median / High Price
$27.31 / $27.31 / $27.31
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$27.31 / $27.31 / $27.31