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South Dakota rates for HCPCS J0725

Injection Chorionic Gonadotropin Per 1 000 Usp Units (Special Coverage Instructions Apply. See Mcm: 2049)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$18.44 / $18.44 / $18.44
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$14.51 / $18.44 / $23.23
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$18.60 / $18.60 / $23.25
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$16.96 / $29.59 / $47.98
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$17.51 / $17.51 / $19.26
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$21.01 / $23.61 / $34.79
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20.38 / $22.65 / $34.79
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.00 / $20.18 / $20.18
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$18.44 / $18.44 / $20.28
Wellmark
Facility/Professional
Facility
Modifier
Low / Median / High Price
$17.51 / $17.51 / $17.51
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$17.51 / $17.51 / $17.51