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South Dakota rates for HCPCS J0740

Injection, cidofovir, 375 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$524.81 / $524.81 / $1,047.13
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$524.81 / $524.81 / $891.25
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$537.03 / $537.03 / $660.69
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$363.08 / $891.25 / $1,445.44
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$446.68 / $524.81 / $549.54
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$630.96 / $630.96 / $630.96
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$575.44 / $575.44 / $575.44
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$398.11 / $524.81 / $575.44
Wellmark
Facility/Professional
Facility
Modifier
Low / Median / High Price
$549.54 / $549.54 / $549.54