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South Dakota rates for HCPCS J1627

Injection, granisetron, extended-release, 0.1 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.29 / $4.29 / $4.29
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.29 / $4.33 / $6.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.90 / $1.12 / $4.29
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.96 / $8.38 / $9.92
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.96 / $4.96 / $24.34
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.95 / $7.17 / $9.64
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.95 / $6.34 / $9.15
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.70 / $4.70 / $4.70
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.29 / $4.29 / $5.51
Wellmark
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.96 / $4.96 / $4.96
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.96 / $4.96 / $4.96