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South Dakota rates for HCPCS J1110

Injection, dihydroergotamine mesylate, per 1 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$60.00 / $60.00 / $60.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.00 / $60.00 / $117.46
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$87.38 / $87.38 / $109.22
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$49.24 / $138.81 / $265.97
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$72.89 / $97.07 / $106.78
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$49.24 / $99.61 / $116.49
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$43.24 / $68.84 / $116.49
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$65.67 / $65.67 / $65.67
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.00 / $60.00 / $66.00
Wellmark
Facility/Professional
Facility
Modifier
Low / Median / High Price
$97.07 / $97.07 / $97.07
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$97.07 / $97.07 / $97.07