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South Dakota rates for HCPCS J0895

Injection, deferoxamine mesylate, 500 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7.94 / $7.94 / $16.98
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.94 / $7.94 / $14.45
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8.71 / $8.71 / $10.72
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$10.72 / $15.14 / $25.12
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.59 / $9.12 / $9.12
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.72 / $10.72 / $10.72
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9.33 / $9.33 / $9.33
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8.51 / $8.51 / $11.75
Wellmark
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8.91 / $8.91 / $8.91