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South Dakota rates for HCPCS J1452

Injection, fomivirsen sodium, intraocular, 1.65 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,000.00 / $1,000.00 / $1,000.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$830.00 / $1,000.00 / $1,000.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$219.75 / $219.75 / $274.69
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,144.00 / $1,346.40 / $2,466.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$212.00 / $212.00 / $233.20
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$660.17 / $660.17 / $1,539.54
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$212.00 / $212.00 / $267.12