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South Dakota rates for HCPCS J1570

Injection, ganciclovir sodium, 500 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$39.54 / $39.54 / $39.54
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$39.54 / $39.54 / $47.94
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.70 / $39.54 / $40.88
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$34.49 / $66.95 / $111.38
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.09 / $39.61 / $43.58
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$34.49 / $47.54 / $87.35
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$33.09 / $49.74 / $90.10
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$43.27 / $43.27 / $43.27
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$37.94 / $39.54 / $43.49
Wellmark
Facility/Professional
Facility
Modifier
Low / Median / High Price
$39.61 / $39.61 / $39.61
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$39.61 / $39.61 / $39.61