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South Dakota rates for HCPCS J0740

Injection Cidofovir 375 Mg (Special Coverage Instructions Apply. See Mcm: 2049)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$546.29 / $546.29 / $546.29
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$546.29 / $551.75 / $640.54
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$531.67 / $546.29 / $664.59
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$361.32 / $894.65 / $1,450.50
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$521.83 / $529.38 / $582.32
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$361.32 / $586.08 / $827.56
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$346.66 / $635.25 / $832.31
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$597.83 / $597.83 / $597.83
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$546.29 / $546.29 / $600.91
Wellmark
Facility/Professional
Facility
Modifier
Low / Median / High Price
$529.38 / $529.38 / $529.38
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$529.38 / $529.38 / $529.38