go back

South Dakota rates for HCPCS J1301

Injection, edaravone, 1 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$20.99 / $20.99 / $20.99
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.03 / $20.99 / $22.80
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$21.38 / $21.38 / $21.38
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20.78 / $20.99 / $25.97
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$20.26 / $26.94 / $51.62
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$18.84 / $18.84 / $20.99
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$22.60 / $26.02 / $37.94
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$22.60 / $24.97 / $51.94
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$22.97 / $22.97 / $22.97
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20.99 / $20.99 / $23.09
Wellmark
Facility/Professional
Facility
Modifier
Low / Median / High Price
$18.84 / $18.84 / $18.84
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$18.84 / $18.84 / $18.84