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South Dakota rates for HCPCS J1620

Injection Gonadorelin Hydrochloride Per 100 Mcg (Special Coverage Instructions Apply. See Mcm: 2049)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$212.61 / $212.61 / $212.61
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$176.47 / $212.61 / $212.61
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$186.38 / $186.38 / $232.97
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$243.23 / $286.26 / $524.29
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$180.30 / $180.30 / $198.33
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$224.71 / $224.71 / $332.51
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$180.30 / $180.30 / $198.33