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South Dakota rates for HCPCS J1410

Injection, estrogen conjugated, per 25 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$392.06 / $392.06 / $392.06
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$392.06 / $392.06 / $472.80
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$390.11 / $392.06 / $487.64
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$384.35 / $558.76 / $1,070.63
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$382.89 / $390.74 / $429.81
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$363.79 / $468.89 / $670.09
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$208.32 / $436.52 / $574.37
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$429.05 / $429.05 / $429.05
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$392.06 / $392.06 / $431.27
Wellmark
Facility/Professional
Facility
Modifier
Low / Median / High Price
$390.74 / $390.74 / $390.74
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$390.74 / $390.74 / $390.74