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South Dakota rates for HCPCS J1455

Injection, foscarnet sodium, per 1,000 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.03 / $6.03 / $13.49
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.03 / $6.03 / $11.48
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.76 / $6.76 / $8.51
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$22.39 / $42.66 / $89.13
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.49 / $15.49 / $21.88
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$18.62 / $18.62 / $18.62
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.41 / $7.41 / $7.41
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.76 / $6.76 / $45.71
Wellmark
Facility/Professional
Facility
Modifier
Low / Median / High Price
$16.22 / $16.22 / $16.22