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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
$16.07 / $16.07 / $16.07
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.74 / $16.07 / $18.85
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$22.01 / $22.01 / $27.52
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$22.28 / $42.69 / $88.93
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.58 / $15.58 / $21.63
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$18.70 / $26.92 / $66.98
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$18.70 / $36.22 / $57.42
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$17.60 / $17.60 / $17.60
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.07 / $16.07 / $38.28
Wellmark
Facility/Professional
Facility
Modifier
Low / Median / High Price
$15.58 / $15.58 / $15.58
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.58 / $15.58 / $15.58