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South Dakota rates for HCPCS J1457

Injection Gallium Nitrate 1 Mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.45 / $1.45 / $1.45
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.12 / $1.45 / $1.99
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.25 / $2.25 / $2.81
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.55 / $1.91 / $3.23
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.29 / $2.40 / $2.64
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.55 / $1.66 / $2.45
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.50 / $2.22 / $3.33
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.40 / $2.40 / $2.64