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South Dakota rates for HCPCS J0775

Collagenase, Clost Hist Inj

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$75.91 / $75.91 / $75.91
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$73.90 / $76.65 / $5,906.70
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$74.78 / $75.91 / $93.47
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$64.73 / $104.62 / $200.46
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$73.16 / $73.16 / $80.48
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$48.79 / $87.80 / $124.06
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$46.43 / $80.81 / $106.33
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$83.07 / $83.07 / $83.70
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$75.91 / $75.91 / $83.50
Wellmark
Facility/Professional
Facility
Modifier
Low / Median / High Price
$73.16 / $73.16 / $73.16
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$73.16 / $73.16 / $73.16