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South Dakota rates for HCPCS J1000

Injection, depo-estradiol cypionate, up to 5 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$49.28 / $49.28 / $49.28
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$49.28 / $49.28 / $56.76
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$43.13 / $43.56 / $53.91
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$23.23 / $67.08 / $128.53
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$42.32 / $46.91 / $51.60
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$23.18 / $46.38 / $56.29
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.13 / $37.04 / $57.98
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.32 / $53.93 / $53.93
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$49.28 / $49.28 / $54.21
Wellmark
Facility/Professional
Facility
Modifier
Low / Median / High Price
$46.91 / $46.91 / $46.91
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$46.91 / $46.91 / $46.91